|
Assisted reproductive technologies are now often used to treat male infertility. The development of the technique of intracytoplasmic sperm injection (ICSI) now means that the management of the infertile man has changed significantly. This in vitro fertilisation (IVF) technique involves the injection of a single sperm into the egg by piercing the shell of the egg. Only a single sperm per egg is needed for this technique. In men with zero sperm counts, if sperm are still being produced, they can be collected from the testis for ICSI/IVF. What if there is no sperm in the ejaculate but sperm are being produced in the testis?A zero sperm count (referred to as azoospermia) can be successfully treated in many cases of infertility, provided sperm are still being produced in the testis. Azoospermia results from one of two reasons:
- Blockage of sperm transport
When azoospermia is due to a blockage of sperm transport, the options for treatment are:
- surgery to remove the blockage OR
- collection of sperm from the testis or epididymis and the use of these sperm in assisted reproductive techniques
 More information: Assisted Reproductive Techniques
- Sperm production problems
When azoospermia is due to poor sperm production, treatment options are more difficult. In the testis of some of these men, small areas of sperm production can still be found even though there are no sperm in the ejaculate. It is thought that these men make very small numbers of sperm but as these sperm pass down the tubes and through to the storage area in the epididymis, the majority of sperm are removed and none reach the ejaculate.
 Back to top
Can surgery repair blockages?When an obstruction (or blockage) has been identified as the cause of male infertility, surgery may be needed to repair or unblock the ducts so that sperm can be transported through the male reproductive tract and be ejaculated as normal.
Some couples become pregnant naturally after surgery to remove blockages (such as vasectomy reversal or blockages caused by infections). The success of surgery depends on the amount of damage and where the blockage is located in the reproductive tract. Blockages near the testes (as in the epididymis) are particularly hard to fix because of the smaller size of the tube and difficulty in locating the site(s) of blockage. Sperm antibodies are also often a problem for men with these blockages and may also reduce the chance of natural pregnancy.
More information: Sperm Antibodies
You should discuss with your surgeon what they believe your success rate might be for this type of procedure. Back to top
What are the risks with surgery to repair blockages?All surgery, particularly where there is a general anaesthetic, has some risks that need to be discussed with the doctor.
The risks with these operations are small, however, sometimes bleeding and infection can develop at the site of the operation. Back to top
What if there is no sperm in the ejaculate to use in ICSI?Men who produce no live sperm in their ejaculate (azoospermia) due to a sperm production problem or a blockage in the reproductive tract, can sometimes have sperm collected by biopsy of the sperm-producing tubes in the testis or other parts of the genital tract.
A diagnostic (test) needle biopsy is sometimes done for these men, using a fine needle inserted into the testis under local anaesthetic. This can help determine the type of problem.
If mature sperm can be found in the tissues of this small sample, more needle biopsies can be done to collect enough sperm for use in ICSI.
For men with severe sperm production problems, where no mature sperm can be seen in a small needle biopsy sample, it still may be possible to get sperm from an open biopsy of the testis under general anaesthetic. More tissue samples can be collected from many sites in this procedure, in order to increase the chance of finding some usable sperm for ICSI. Back to top
What are the chances of finding sperm by testicular biopsy? Success rates for both needle and open testicular biopsies vary and depend on the reason for the infertility problem.
The chance of finding sperm using a needle biopsy is excellent in all cases of azoospermia caused by a blockage of the reproductive tract.
Chances of finding sperm are low for men who have sperm production problems such as germ cell arrest or Sertoli cell-only syndrome. However, the chances are better for men with hypospermatogenesis.
Many couples decide that a small chance of finding sperm in an open biopsy is not worth the risk and may want to use donor sperm instead. Others may wish to take every opportunity to have their own child. Back to top
What are the risks with a testicular biopsy?A needle biopsy has an excellent safety record. However, bleeding can happen and the testis can swell and be sore for up to three days. Infection and bleeding sometimes happen, but these problems generally clear up easily. Less than one in 100 men have bleeding or infection around the wound after a biopsy.
Discomfort is common for a few days after the open biopsy procedure. Supportive underwear may help.
Damage to the testis may result from larger testicular biopsies and can reduce the ability of the testis to make the male sex hormone, testosterone. This may lead to a life-long need for testosterone replacement therapy.
More information: Testosterone replacement therapy
The use of ICSI/IVF in combination with a needle or open biopsy procedure switches the focus from the treatment of the infertile male to that of the female. The full details and risks of stimulation of the ovaries and egg collection procedures that the woman will require as part of this treatment must be considered. Back to top
Can sperm collected from the testis be frozen for later use? Medical research is currently looking at separating the biopsy procedure and sperm collection process from the attempt at ICSI/IVF. The technique of freezing sperm from testicular tissue needs to be improved in order to do this successfully. When this technique has been perfected, it will be possible to collect sperm from an open biopsy and store it before any attempt at female egg collection and ICSI/IVF. This would remove the need for couples to grapple with whether to use donor sperm if sperm collection fails during an attempt at ICSI/IVF where the female has already had eggs collected. Back to top
|
