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.
Sperm Injection (ICSI)
has revolutionized the treatment of severe male factor problems, especially
when the sperm is surgically retrieved.
Donor Sperm Insemination - DI
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 -
This is a technique for collecting immature sperm directly from
the vas, epididymis or testes. Sperm retrieval may be performed under
local anaesthetic, as an out patient procedure, under general anaesthetic
or during another operation to repair an obstruction in the vas. In
this case a man has no sperm in his ejaculate,
surgical sperm retrieval may be used to extract sperm from various parts
of the male reproductive tract, most frequently from the epididymis
( percutaneous epididymal sperm aspiration - 'PESA' ), or directly from
the testicles ( testicular sperm aspiration - 'TESA' or testicular sperm
extraction - 'TESE' ). These techniques must be used in conjunction
with intracytoplasmic sperm injection (ICSI), as sperm retrieved in
this way are immature, and are incapable of fertilisation without assistance.
- Percutancous Epididymal Sperm Aspiration.
- 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.
This technique is used to obtain sperm from spinal
injured or otherwise impotent men. These sperm can be used for intrauterine
insemination, IVF or ICSI, depending on the quality.