Treatment For Male Infertility

A) Low sperm count

Low sperm count is a condition in which the sperm count is below 15 million/ml , that is oligospermia.

When there are no sperms in the sample , it is called Azoospermia.

Azoospermia can be obstructive or non obstructive.

Obstructive azoospermia is due to block in the passage that the sperm has to travel. Ex -Absence of Vas deferens.

Non obstructive azoospermia is due to very low production or non production of sperms.

Common Causes-

• Genital surgeries
• Undescended testis in adolescence
• Disease of genital tract
• Past history of Mumps
• Causes leading to increased heat in genitalia- Testis are placed outside the human body as they need lower than body temperatures to survive. Excessive heat can lead to damage to sperm production. Ex- Obese men (due to sagging layers of fat), truck drivers , tight underclothings, excessive sauna etc
• Smoking especially more than 20 cigarettes per day
• Excessive ejaculation- 2 to 3 times a day
• Genetic causes like CBAVD (Congenital bilateral absence of Vas Deferens) , Y chromosome microdeletion etc

Treatment options-

• Treating Infections with antibiotics: Infections if present should be treated with the help of antibiotics. This is not always helpful. Medications can be given to correct hormonal issues.
• Correctable surgeries- Varicocele or an obstructed vas deferens may be repaired. In persistant oligospermia, IVF treatment offers good pregnancy results. To attain pregnancy via IVF treatment, even low sperm counts are sufficient.
• In Azoospermia, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
• In PESA (percutaneous epididymal sperm aspiration), sperms are usually recovered from the epididymis by puncturing it with a fine needle.
• In TESA or testicular sperm aspiration (also known as TESE, or testicular sperm extraction), testicular tissue is sucked out through a fine needle, under local anaesthesia. The sperm are then liberated from tissue and used for ICSI.
• In case no sperms can be extracted through surgical procedure, semen sample from a matched donor can be used for IUI or ART treatment.

B) Low sperm motility

Sperm motility treatment refers to the movement of sperm. Poor sperm motility means that the sperm do not swim properly, which can lead to male infertility.

Normally atleast 32% of the sample should show forward progressive motility.

Treatment options:

1) Lifestyle modification

• Reduce chemical exposure
• Improve diet
• Exercise regularly
• Take nutritional supplements- Antioxidants to reduce stress
• Stop Smoking, tobacco, alcohol, marijuana
• Stop using any anabolic steroids including any testosterone supplements

2) IUI (Intrauterine insemination)

• Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed into the uterine cavity with the help of a catheter in and around the time of ovulation (release of egg from the ovary)
• The purpose of IUI treatment is to introduce the best and the most motile sperms high up in the uterine cavity i.e. as close to the ovum as possible so that the sperms have to travel the least distance
• Procedure and details are described separately

2) IVF and ICSI

In semen sample having very low or even no motility, live but non motile sperms can be used to obtain promising results with ICSI. IVF and ICSI treatment have delivered the most promising results in cases of low count and motility.

IVF with ICSI treatment has delivered most promising results in male infertilty.

C) Erectile and ejaculatory dysfunction

Erectile and ejaculatory dysfunction require details history taking and counselling. At time, it can be corrected with the help of medications or use of vibrator.

If not correctable, Sperm sample can always be obtained by surgical procedures and ICSI treatment done to attain pregnancy.