TREATMENT OPTIONS FOR MALE INFERTILITY

1. Microsurgery in obstructive azoospermia

2. Intrauterine Insemination in male infertility (IUI) 

3. In Vitro Fertilization (IVF & ET) – ‘Test Tube Baby’

4. ICSI - A Reproductive Revolution for male infertility. 

5. What is ICSI? 

6. Percutaneous Epididymal Sperm Aspiration(PESA) 

7. Micro Epididymal Sperm Aspiration (MESA) 

8. Modified Testicular Sperm Extraction(TESE)

Micro Surgery in Obstructive Azoospermia: -

Microsurgical Vasovasostomy (Micro VVA) and newer techniques of Microsurgical Vaso Epididymal Anastomosis(Micro VEA) have very good success rates. In cases of obstructive azoospermia, these procedures are preferred instead of Assisted Production with ICSI.

Intrauterine Insemination (IUI):- 

IUI could be considered only in cases of men with normal or near normal semen parameters or idiopathic infertility, cervical hostility or failure of deposition of sperms due to erectile or ejaculatory dysfunction.

INTRAUTERINE INSEMINATION ( IUI )

Intrauterine Insemination success rates vary considerably and depend on :

  • Age of the woman 

  • Type of ovarian stimulation used

  • Duration of infertility 

  • Cause of  infertility 

  • Number and quality of motile sperm 

  • Other factors

Success rates for IUI in women over 35 drop off , and for women over 40 they are much lower. 


A reproductive revolution for male infertility

INTRA CYTOPLASMIC SPERM INJECTION ( ICSI)

With ICSI procedure, men with severe oligo asthenospermia and azoospermia have an opportunity to produce their own biological child, without resorting to Donor Insemination or Adoption. In cases of Congenital Bilateral Vasal Agenesis (Absence of VAS), failed vasoepididymal anastomosis(VEA) and non obstructive azoospermia, ICSI has proved to be successful. In cases of repeated failure with conventional In Vitro fertilization, ICSI could be considered to maximize the chances.

What is ICSI ?

ICSI (Intracytoplasmic Sperm Injection), is a procedure where a single sperm is injected into the egg. To achieve fertilization the sperm is withdrawn into a tiny pipette, the egg fixed with a holding pipette and the sperm injected into the cytoplasm of the metaphase II (mature Oocyte). After the ICSI procedure the Oocytes are incubated and the resultant embryos are transferred into Uterine cavity by using a specially designed embryo transfer catheter. After the embryo transfer, Progesterone supplementation is given. The confirmation of Pregnancy done with estimation of HCG and after 6 weeks for the foetal heart on ultrasound. 

Sperm Retrieval Methods for ICSI 

In Cases of obstructive azoospermia sperms are retrieved by 

1. Percutaneous Epididymal Sperm Aspiration ( PESA)

2. Micro Epididymal Sperm Aspiration ( MESA) 

3. Modified Testicular Sperm Aspiration ( TESE)

Percutaneous Epididymal Sperm Aspiration 

( PESA)

Case of blocks to sperm pathways epididymis or VAS, the epididymal ducts are dilated which contain plenty of motile sperms. Using a 21 guage butterfly needle attached to a 20ml syringe, fluid is drawn and examined under microscope. This is a simple procedure which does not involve operative surgical expertise

Micro Epididymal Sperm Aspiration ( MESA) 

This is a good procedure for retrieving sperms from dilated epididymal tubules using magnification. The individual tubule is entered and fluid aspirated and examined for the presence of sperms. 

Modified Testicular Sperm Aspiration ( TESE)

Non Obstructive Azoospermia, most of the tubules show atrophic changes. Still there could be some tubules which may contain sperms adequate for purpose of ICSI. A few seminiferous tubules are thus excised and they are teased out for presence of sperms. These cases of Non Obstructive Azoospermia are not suitable for any form of medical or surgical treatment and ICSI with the sperms recovered from the testis is the only option for them to get biologically their own child.