Male infertility treatment is aimed at correcting the underlying cause of infertility.
Male infertility treatment is geared toward identifying the cause of infertility, determining the best choice for treatment, and achieving pregnancy. There are many factors that can contribute to male infertility, as well as options for targeting and correcting the problem.
A varicocele is a dilated vein in the scrotum that allows blood to pool and impair semen quality. Should a varicocele be present, and semen quality is impacted, a varicocelectomy (varicocele repair) can be performed. Specialists believe that varicoceles disrupt the cooling mechanism of the testes, causing the testicles to overheat. This decreases sperm production and/or interferes with sperm function. Varicocele repair has been shown to enhance semen parameter and pregnancy rates, and is considered the most common male infertility treatment. Following this procedure, approximately 70% of patients will show improvement in their semen quality. Many men have varicoceles, yet they are not always the cause of infertility.
Some men will have no sperm in the ejaculate but will have normal sperm production.
When sperm is not found in ejaculate, this typically results from a blockage in the sperm transport system. A thorough medical history, physical examination, and a diagnostic biopsy of the testis can determine a blockage. Obstruction at the epididymis can be congenital (developed at birth) or caused by infection, trauma, or a vasectomy (epididymal blowout). In many cases, obstructions are treatable. A TRUS (transrectal ultrasound) can be performed to determine where the blockage lies. Because of its ability to provide excellent visualization of the seminal vesicles, prostate, and ejaculatory duct, TRUS has become an important diagnostic technique in the evaluation process.
If the ultrasound is normal, the next step may be to biopsy the testicle. If the testicular biopsy is normal, then a blockage may be present in the epididymis or vas deferens. If azoospermia (no sperm) is present in a man who has had a vasectomy, vasovasostomy (Vasectomy Reversal) may be an option. Another male infertility treatment option is a microscopic epididymal sperm aspiration or (MESA).
Since hormones are necessary for the production and maintenance of sperm, hormonal problems can cause infertility.
The pituitary gland, in the middle of the brain, secretes follicle stimulating hormones (FSH) and luteinizing hormones (LH), which affect the testicle. FSH stimulates Sertoli cells in the testicles, which supports and nurtures sperm. LH stimulates cells that make testosterone, which is necessary for sperm production. Problems with either or both of these hormones can contribute to fertility problems. These substances are easily measured in blood and imbalances are treatable.
Many substances in the environment, including the food we eat, medicines we take, and lifestyle habits can negatively affect sperm production. Smoking, excessive alcoholic intake, and exposure to certain chemicals (such as pesticides and insecticides) an impact sperm production and quality.
Prostatitis, pyospermia and retrograde ejaculation
If prostatitis or pyospermia are present, treatment with antibiotics is recommended. If retrograde ejaculation is present, steps can be taken to ensure antegrade ejaculation. Semen can also be obtained from a post-ejaculatory void and used for artificial insemination.
Antisperm antibodies can cause infertility.
When sperm takes on new proteins during maturation, that are unknown to the immune system, they become like foreign cells to the body. Sperm hide from the immune system in the testicle, where a barrier keeps blood and white blood cells away from them. This prevents men from having an allergic reaction to their own sperm. Sometimes, the immune system sees sperm and produces antibodies to attack them. These antisperm antibodies (ASA) may affect the mobility or function of the sperm. If antisperm antibodies are present, a course of steroids may be effective.
Some men will have disorders that affect the ability for a man to ejaculate normally.
Abnormal ejaculation can impact a man’s fertility. Retrograde ejaculation (sperm ejaculated into the bladder instead of through the penis), along with an inability to ejaculate, will interfere with fertility. A retrograde semen analysis can be performed to determine if there is sperm in the urine.
If you would like to learn more about male infertility treatment options, contact Urology Austin to schedule an appointment with one of our urologists.