The male genital tract includes the testes, the epididymis, the vas, the prostate and urethra. The testes situated in the scrotum are mainly made up of loops of fine tubes (seminiferous tubules) which produce the sperm. The sperm cells mature as they pass through the epidiymis (a narrow system of tubes on the surface of the testes). The vas is a hollow tube, which carries the sperm from the epididymis to the urethra.
It takes 3 - 4 months for sperm to develop, during this time sperm production may be affected by febrile illness, exposure to drugs, toxins, radiation, local trauma or infection.
The primary laboratory test for male fertility is " semen analysis". The sample is obtained by masturbation or collected from a special condom following intercourse. Sterile containers must be used to collect the sample following three days of sexual abstinence.
A normal assessment should show :
Common Male Infertility Problems :
Intrauterine Insemination - IUI combined with superovulation using washed sperm can be considered in mild abnormalities in sperm parameters or in cases of coital difficulties.
In Vitro Fertilisation - IVF may be used for certain types of male infertility, such as those with slightly reduced sperm counts or anti-sperm antibodies, a form of immune infertility, with IVF relatively fewer motile sperm are required for oocyte fertilisation because the natural transport barriers are bypassed; moreover IVF increases the number of sperms in contact with multiple oocytes from superovulation. However there now exist a number of more specialised options for treating severe male infertility.
Intracytoplasmic sperm injection (ICSI) - This technique involves the use of micromanipulators to inject a single sperm into each egg. It is used for cases where very few functional sperm are available, for patients who have previously failed to achieve fertilisation with IVF, for patients with known functional sperm defects and for patients who require surgical sperm retrieval.
ICSI has revolutionized the treatment of severe male factor problems, especially when the sperm is surgically retrieved.
Donor Sperm Insemination - DI Donor Insemination
Intrauterine insemination with the use of donor sperm may be indicated when the male partner's sperm is severely suboptimal. This treatment will always be an option in severe cases of male factor infertility, azoospermia or genetically transmitted disease.
Surgical Sperm Retrieval -
PESA - Percutancous Epididymal Sperm Aspiration.
TESE - Testicular Sperm Extraction. If sperm are not found, a sample of tissue (testicular biopsy) can be taken from the testes through a small incision, 2 - 3 stitches are placed in the skin which self dissolve in about 10 days. Once the sperm have been collected, fertilisation is achieved using Intracytoplasmic Sperm Injection (ICSI.) This involves injecting a single sperm directly into the egg. Excess sperm from the sample can be cryropreserved for possible future use.