MALE INFERTILITY

Male infertility is a condition where the male in a relationship affects the child-bearing ability of the woman. When couples are not able to conceive even after having unprotected sex over a long period of time, it is important that men as well as women get screened for fertility.

Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg.

Sperm Production Problems

Problems with sperm may exist from birth or develop later in life due to illness or injury.

Sperm production problems: The quality and quantity of sperm are the key factors to male fertility. Any defect such as immature sperm or low sperm count (oligospermia) can lead to infertility.

Causes of low Sperm Counts

Some men produce no sperm, or produce too few sperm. Lifestyle can influence the number and quality of a man’s sperm.

Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.

One third of all infertility cases have been linked solely to issues with the male partner. Male fertility may be impaired by a number of factors. These include:

Other Causes of Male Infertility

Other causes of Male Infertility:

  • Varicoceles: This is a condition characterized by swelling of the veins that supply the testicle.

  • Backward ejaculation of the sperm

  • Blockage of the sperm-carrying ducts

  • Development of sperm antibodies (auto-immune disorder)

  • Hormonal/stress problems

  • Infections/tumors of the male reproductive system

  • Genetics (chromosomal disorders)

  • Sexual problems

  • Use of certain medications such as steroids

  • Excessive radiation exposure affects the sperm production.

  • Work-related causes (example: laptop use elevates the temperature of the testes leading to low sperm production)

  • Smoking and alcohol abuse

Treatments for Male Infertility

With the advancements in medical technology, it is now possible to treat this condition. Treatment options include:

  • Surgery: Surgery is indicated in cases of varicocele and obstruction of the sperm duct to improve the sperm motion.

  • Medications: Antibiotics are prescribed to treat infections of the reproductive system.

  • Treatment for sexual problems: Counselling about sex and relationships can help boost fertility levels.

  • Male hormone replacement therapy may be used to treat hormonal deficiency.

  • Assisted reproductive technology (ART): These are revolutionary treatment procedures that can help couples with infertility problems to conceive. Some of them include in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) methods.

  • Lifestyle modification: This would include changing habits such as not smoking, limiting alcohol intake, and using stress reduction techniques.

  • women can keep track of changes in her morning body temperature and the texture of the  cervical mucus, or

  • consider a home ovulation test kit, which can be bought at a pharmacy.

Cancer Related Issues for Fertility

Radiotherapy and chemotherapy may damage the quantity and quality of sperm in men, and decrease the number of mature healthy eggs produced in women.

Cancers of the reproductive organs such as the testicles, ovaries, uterus, fallopian tubes and cervix may require surgical removal, thus affecting the ability to reproduce. Cancer treatment can also increase the risk of early menopause in women, making them infertile at a much younger age.

Preservation Prior to Cancer Therapy

Since avoiding cancer treatment is not an option, there are methods to preserve your fertility. Fertility-preserving procedures are most commonly performed before cancer treatment. It is important that you talk to Dr Alexander about these methods and plan early to preserve your fertility.

Fertility-preserving options in men

The options for men may include:

Physically protecting the testes from radiation therapy.

Testicular sperm extraction and epididymal sperm aspiration involves removing a small amount of tissue from the testicles or epididymis. The mature sperm are frozen and stored for later use through assisted reproduction (a technique of artificially fertilizing a preserved sperm with a woman’s egg outside the body, and transferring the embryo into the uterus for development).

In boys who have not entered puberty, a small portion of the testicular tissue, containing stem cells that will eventually become sperm, is extracted, frozen and stored.

Sperm banking involves preserving (freezing) semen for assisted reproductive procedures.

Robotic treatment for male infertility

Male infertility is a significant cause of infertility in almost half of infertile couples. Over the last several decades, treatment of infertility has advanced with the emergence of new assisted reproduction techniques like In-Vitro Fertilization (IVF), Intra-Cytoplasmic Sperm Injection (ICSCI), and microsurgery techniques including robotic surgery. Advanced robotic surgery has a remarkable success rate and is of exceptional advantage in treating male infertility.

Surgical procedures performed using robotic technology allow for unmatched precision, dexterity and control for the surgeon compared to other conventional techniques. Robotic surgery is less invasive, safe and offers several advantages over traditional open surgery. Furthermore, patients experience much less pain, minimal scarring, decreased blood loss, less complications and shorter hospital stay with an early recovery and return to work.

The robotic treatment options available to treat male infertility include:  

Robotic Vasectomy Reversal

Robotic vasectomy reversal or robotic vasovasostomy is an operative procedure to restore fertility to previously vasectomized men. The procedure involves reconnecting the cut ends of the vas deferens (a tube for passage of sperm from the testicle to the urethra) during vasectomy. Most of the vasectomized men are likely to have an obstruction in the epididymis (the storage vessel for sperm, located behind the testicle). In such patients, Robotic Vasoepididymostomy is the available option. Robotic vasoepididymostomy involves cutting the distal end of vas deferens and connecting it directly to the epididymal tubule above the level of blockage or obstruction in the epididymis. Robotic surgery reduces overall surgery time, improves the healing rate and allows more flexible and precise suturing of the incision. Bleeding within the scrotum, infection, blockage of the vas deferens (possibly by blood clots), and damage to nerves and blood vessels impeding fertility are the possible complications after a robotic vasectomy reversal.

Robotic TESE (Testicular Sperm Extraction)

In azoospermic men, who have no sperm in their ejaculate, robotic testicular sperm extraction (TESE) is a possible option to retrieve sperm flow. The robotic TESE improves the performance of mapping testicular blood flow, determines the areas of concealed sperm in the testes for extraction, and helps to cure infertility.

Robotic assisted microsurgical varicocelectomy is a suitable surgical option for infertile men with varicocele, dilation of the pampiniform venous plexus in the scrotum. These dilated veins can cause sperm abnormalities and lead to infertility.  Varicocelectomy procedure involves ligation of the dilated and abnormal veins that drain the testicle.