Treatment of male infertility

In recent years there has been a great increase in scientific and medical interest in male infertility and the range of treatment options currently available includes drug therapy, surgery and ART. The main approches to the treatment to male infertility are summarized and described below.

Fewer than 5% of infertile men have a hormonal disorder that can be treated with hormone therapy. Hormonal imbalances caused by a dysfuction inthe mechanism of interaction between the hypothalamus, the pituitary gland and the testes directly affect the development of sperm. In this type of fertility disorder, FSH therapy is highly successful. Gonadotropins are sometimes chosen to treat unexplained male infertility, as seen in the cases of oligozoospermia (when sperm count is abnormally low) or asthenospermia (when less than 40% of the sperm are motile). Other types of drug treatment include antibiotics to treat infertility resulting from infections and treatment with bromocriptine when impaired sperm production is due to hyperprolactinaemia (increased levels of prolactin hormone in the blood).

Surgical therapy in male infertility aims at overcoming anatomical barriers impeding sperm production and maturation (in the testes and the epididymis) or ejaculation. Several techniques have been developed, whereby spermatozoa are retrieved either from the epididymis (percutaneous epididymal sperm aspiration, PESA, or microsurgical epididymal sperm aspiration MESA) or from the testes (testicular sperm aspiration, TESA or testicular sperm extraction, TESE). These techniques are mainly used in conjuction with ICSI.

Some of the ART procedures described as treatment for female infertility are relevant to certain types of male infertility also.

Intracytoplasmic sperm injection is a micromanipulation technique in which fertilization is brought about by the injection of a single spermatozoon imto an unfertilized egg (or oocyte). ICSI is performed with eggs obtained after ovulation stimulation as for IVF, and has greatly improved the treatment of male infertility as a result of severe oligozoospermia (abnormally low sperm count).

ICSI requires only one spermatozoon for each egg and because of this, its indications have been expanded to include nearly all men with serious infertility, including man who would previously have been considered hopeless cases. provided the psermatozoa are viable, even sperm dysfunction may be overcome, since more than 50% of eggs fertilize normally regardless of the sperm quality. Obstructive azoospermia (absence of sperm in the ejaculate) can also be treated by retrieval of spermatozoa directly form the testes and even immature psermatozoa have been used to produce embryos.

The success rate in ICSI are greatly influenced by the quality of sperm preparation and by the skill of micromanipulation. ICSI, combined with IVF, is the most effective treatment for male infertility with a success rate of 20-25% of treatments resulting in a live birth.