Treatment for infertility in men – what’s available?

Infertility in men can be caused by a range of factors and it is important to have fertility testing to discover the exact nature of the problem, if possible. Common causes of infertility in men include:

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  • Having a low sperm count.
  • Having a hormone problem that affects sperm production.
  • Having a blocked vas deferens so no sperm can reach the semen. This can be caused by a genetic disorder such as cystic fibrosis, or it can result from testicular cancer or an enlarged varicose vein.
  • Having sperm that do not swim actively enough to reach the egg in the female’s uterus.
  • Having a genetic or structural problem in the testes that prevents sperm production or release.

Once the cause of male infertility is found, it may be possible to correct the hormone imbalance or to perform surgery to remove the blockage from the testes.

It is possible for a man who has retrograde ejaculation, where sperm travel backwards into the bladder, to produce enough sperm for a cycle of intrauterine insemination (IUI), as sperm production in this type of infertility in men is usually normal in quantity and quality. After the sperm has been carefully washed it can be introduced directly into the female partner’s uterus to try to establish a natural fertilisation.

Other problems are usually treated using in vitro fertilisation (IVF), which can be combined with intracytoplasmic sperm injection (ICSI).

When infertility in men is due to a very low sperm count, or an absence of sperm in the ejaculated semen, it is possible for him to have surgical sperm retrieval using a technique such as percutaneous sperm aspiration (PESA), testicular sperm aspiration (TESA) or microsurgical epididymal sperm aspiration (MESA). Relatively small numbers of sperm are extracted using a needle, a biopsy tool, or using microsurgery, then they can either be used in a standard IVF procedure or in ICSI to achieve fertilisation.

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