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Even those men with a zero sperm count may be producing sperm in their testes that can be collected and used in assisted reproductive technologies. |
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It is important that the cause of infertility is diagnosed before proceeding with assisted reproductive technologies as in many cases it may be treatable without the need for in vitro fertilisation (IVF) techniques. IVF does not treat the cause of male infertility but it may help to overcome the problem by achieving a pregnancy which, for many couples, is the outcome they most desire. Assisted reproductive technologies will involve you as a couple. What are assisted reproductive technologies?Assisted reproductive technologies (such as in vitro fertilisation, IVF) do not treat the cause of male infertility. However, they can help couples become pregnant.
Assisted reproductive technologies are now often used to help infertile men father children. In Australia, about four in every 10 infertile couples use assisted reproductive technologies because of a male infertility problem.
Originally, IVF was developed as a medical technique to overcome female infertility. In 1993, the introduction of a technique called intracytoplasmic sperm injection (ICSI) greatly helped men with very low sperm counts who were previously untreatable by standard IVF procedures.  Back to top
What is in vitro fertilisation (IVF)?In vitro fertilisation (IVF) is a more traditional form of assisted reproduction where sperm collected from the male is mixed with the eggs from the female partner.
The female partner is given fertility drugs in order to produce an increased number of eggs that are removed surgically.
The sperm is collected by masturbation and mixed with eggs from the female partner in a dish or tube to create embryos, which are then placed back into the woman.
This form of IVF works for many couples, but the pregnancy rates for couples with severe male infertility are generally quite poor. Therefore, ICSI is the more common treatment today and has greatly improved the chances for men with poor sperm production. Back to top
What is intracytoplasmic sperm injection (ICSI)?Intracytoplasmic sperm injection (ICSI) is a form of IVF (often referred to as ICSI/IVF). ICSI is a technique in which single sperm are injected directly into the egg by piercing the outer covering of the egg (zona pellucida). This technique can achieve pregnancies even when only a few sperm are produced. The sperm are collected from the semen ejaculate or removed carefully from the testis or epididymis. A skilled medical scientist (embryologist) then injects one sperm into each egg under a microscope.
Pregnancy rates for ICSI range from 10 to 40 per cent. Success largely depends on other factors, such as the age and reproductive health of the female.
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What issues need to be thought about when having ICSI?Research has shown that the quality of sperm collected for ICSI is often quite poor. Some men with low sperm counts have sperm with chromosomal problems. There is a greater risk of chromosomal imbalance (aneuploidy) where the sperm has extra or missing chromosomes that does not allow normal embryo development. Some genetic disorders may be passed on to the child and may not appear until after birth or later in life. Male children are also at greater risk of inheriting fertility problems, as some of these problems are caused by disorders of the Y chromosome which is passed down to sons. Back to top
What are the risks associated with assisted reproductive technologies?If a couple decides to proceed with assisted reproductive technologies to treat infertility problems, it should be remembered that ICSI/IVF exposes the woman to risk. The use of ICSI/IVF in a woman may cause overstimulation of the ovaries from the fertility drugs and carries the risks associated with surgical collection of eggs from the ovaries. It is important that the full details of risks for the woman are explained to the couple. The use of ICSI/IVF switches the focus from the man to the woman. Most couples accept this switch in order to try and have children. The decision about choice of treatment requires careful thought and discussion with your doctor. Back to top
What should be expected at an infertility clinic?Note:
Legislative guidelines on assisted reproductive techniques differ between states and territories. |
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If a couple goes ahead with assisted reproduction such as IVF, the infertility clinic will explain all the procedures and success rates for the type of infertility problem. Some areas for consideration include:
Possible Setbacks and Failure
When making a decision to take part in an assisted reproduction or IVF program, it is important to know that the chance of success depends on many factors. The type of fertility problem, the age of the female partner and the type of treatment used, can give couples between 10 to 40 per cent chance of becoming pregnant. Many couples have a number of treatment cycles before conceiving whilst others never have children.
Female Focus
Most attention during assisted reproduction is given to the woman as she has more medical procedures and the infertility specialists are gynaecologists. Men are encouraged to support their partners and to have an active role in the process. Men also have concerns such as the pressure of producing sperm when required or about the testis biopsy procedure. It is important that men ask for help or information when needed. Staff at infertility clinics recognise the importance of men’s concerns and will try to help where they can.
Semen collection
For most types of IVF procedures, men will need to produce a semen sample on the day of their partner’s egg collection. Samples provided for testing and diagnosis are not used in the insemination procedure and another fresh semen sample is needed. Private rooms at reproductive clinics are available for men to produce semen samples by masturbation into the sterile containers provided.
Many men have difficulty producing a semen sample under pressure. Clinics can sometimes arrange for the female partner to join the man in the room and can also provide special condoms for the collection of semen by sexual intercourse. Standard condoms cannot be used to collect semen for IVF as they usually have lubricants and spermicides that kill sperm.
Blood tests
Both male and female partners may need to have blood tests to check for infectious diseases such as HIV and hepatitis, before starting on an IVF program.
Legislation and Code of Practice
Most clinics offering assisted reproductive technologies operate under legislative guidelines which may differ between each state and territory. When deciding to start infertility treatment, couples will be fully informed of any legislation that may affect treatment, donation and storage procedures. The treating doctor and counsellors specially trained in infertility issues are available to discuss any legislative issues and help couples make informed decisions about their treatment.
The Reproductive Technology Accreditation Committee (RTAC), established by the Fertility Society of Australia, also provides a Code of Practice for clinics offering in vitro fertilisation (IVF) and related technologies. Clinics offering assisted reproductive technologies must be accredited by RTAC.
Counselling
Specialised counselling services are provided in clinics offering assisted reproductive technologies. The services of a professional counsellor may help individuals and couples at times of stress, such as at initial diagnosis, and also provides information and support at any stage of treatment. In some states in Australia, counselling is compulsory before treatment starts. Back to top
What are the success rates with assisted reproductive technologies?ICSI can result in pregnancy rates up to 40 per cent per treatment cycle. This is a significant increase on traditional IVF techniques for the treatment of male infertility, which were used before ICSI was developed.
A number of factors, such as the age and fertility status of the female partner, need to be taken into consideration when reviewing a couple’s chance of achieving a pregnancy by different assisted reproductive technologies. Infertility clinics can often provide more information about pregnancy outcomes for the different treatment options they offer.
On behalf of the Fertility Society of Australia, overall success rates of assisted reproductive technologies throughout Australia and New Zealand are collected by the National Perinatal Statistics Unit.
 Related link: National Perinatal Statistics Unit
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