Male infertility treatments

Drug treatments

Several drugs have been tried to improve the sperm count, including androgens, FSH injections, steroids, and antioxidants (vitamins E and C). None of these have been found to be beneficial, though variable successes have been described with steroids for antisperm antibodies and antioxidants, and further studies are awaited.

With the presence of sperm antibodies, steroid treatment used to be given to reduce antibody levels but these drugs can have side-effects. Another option is to wash the sperm in a centrifuge to remove the antibodies.

Hormonal treatments, such as clomiphene, are sometimes used where if you have a low sperm count with no obvious explanation. Medication can be used for some ejaculation problems, for example, to tighten the bladder neck in cases of retrograde ejaculation, a problem that can sometimes arise after prostate surgery.

Varicocele ligation

This involves tying or clipping the testicular veins causing the varicocele swelling in the scrotum . The procedure is carried out using a minimally invasive, laparoscopic approach or with the microscope and is also beneficial if your varicocele is painful.

Electroejaculation

This procedure, which takes place under general anaesthetic, involves inserting a probe into the rectum which carries a small electrical current. This current stimulates the surrounding nerves and leads to ejaculation. It is used for men with anejaculation where there is failure of contraction of the sperm tubes, often seen as a consequence of diabetes or following a spinal cord injury.

Ferticare stimulation for spinal cord injuries

This approach works on the same basis as electroejaculation, but uses mechanical stimulation rather than electrical nerve stimulation. A vibrator is used to manually stimulate ejaculation. This treatment can be effective for men who have had a spinal cord injury and those who have a normal sperm count but experience ejaculation problems.

Non-obstructive azoospermia sperm retrievals

Azoospermia refers to a complete absence of sperm in the ejaculate. Sometimes, a specialist sperm retrieval technique can be used to isolate a small number of sperm, even if standard sperm analysis has indicated there is no sperm present. This involves preparing the ejaculate with a method called a density gradient that separates out any sperm present and concentrates them into tiny droplets. If no sperm is found using this method, we will then proceed to retrieving sperm directly from the testicles.

Surgical sperm retrieval

Sperm retrieval is a broad term, covering a variety of techniques used to obtain sperm directly from the testicles or epididymis, rather than taking sperm from the ejaculate. This approach is suitable for men with absent sperm in sample analysis. Sperm retrieval is then combined with ICSI or IUI in order to assist conception. We are experienced in all sperm retrieval techniques and will select the best option for each patient to achieve the optimal results. These techniques include:

Percutaneous sperm retrieval (PESA)

This procedure is performed under a local anaesthetic and usually takes 20 minutes. A needle is inserted through the scrotum into the epididymis in order to remove the sperm from inside. Ten to 20 million sperm are removed during several aspirations in one or both epididymi. Sperm removed from the epididymis are not yet mature, meaning that the use of ICSI is necessary in order to fertilize an egg in order for pregnancy to occur.

Testicular sperm extraction (TESE)

Many methods can be used to extract sperm directly from the testis. A testicular aspiration is often tried first but often a microsurgical sperm extraction is needed where a small amount of tissue is excised and the laboratory staff are able to extract sperm from the deeper parts of the tissue. Using these techniques sperms can be found in very unfavourable cases.

Intrauterine Insemination (IUI)

This involves removing and preparing a semen sample in order to have a higher concentration of the most motile (sperm with the best movement) sperms. The sample is then injected through the cervix at the time of ovulation. IUI is often combined with the woman taking drugs to stimulate the ovaries to make larger numbers of eggs, further improving the chances of pregnancy. For couples with male infertility, the success rate of ovarian stimulation combined with IUI is 7 to 8 per cent per cycle, compared with 2 to 3 per cent without treatment.

Intracytoplasmic Insemination (ICSI)

This is a form of IVF (in vitro fertilisation) when one sperm is injected directly into one egg in order to fertilise it. This can be effective for men with very low sperm counts. Sperm can even be retrieved during a testicular biopsy under anaesthetic, enabling the surgeon to find sperm in men whose sperm analysis sample has been without sperm. The overall live birth rate is 30% per cycle.