Male Fertility Treatments

Female and male contribute equally to a successful conception and a healthy child.  Male factors alone account for one-third of fertility problems in Australian couples and are present in around half of all couples who seek fertility treatment. The male side, however, often have been overlooked. By identifying at the outset whether male infertility is present through a simple, non-invasive semen analysis can avoid putting women through the risk and discomfort of unnecessary invasive and expensive investigations such as laparoscopy.

I provide highly specialised medical and microsurgical treatments for men with fertility problems, including treatments to improve spermatogenesis and qualities, and for men who do not have sperm in ejaculate (azoospermia) sperm retrieval through microdissection using a high power operative microscope to identify and selectively remove tubules within the testes that contain sperm while minimising blood vessel damage and tissue removal.

About Male Fertility

Sperm production takes 2.5 months in testes with an additional 0.5 months to travel out, a process very sensitive to our state of health.  This goes beyond the semen parameters which determine ability to fertilise (to achieve a pregnancy), but on long term health of the children through influence on the integrity and epigenetic modifications of the male genetic contribution (DNA) delivered by sperm.

Spermatogenesis are highly sensitive to body function and environment; abnormal semen findings may attribute to episodes of febrile illness 2 month earlier.

Lifestyle factors and our health conditions have importance influence on spermatogenesis. These need to be kept in mind when one tries to start a family.

In general, anything one can do to achieve healthy longevity will be good for reproductive performance. Habits and lifestyle factors which can lead to ill health and shorten life expectancy, all have negative impacts on sperm production and health.  Smoking, excessive alcohol, recreational drugs including anabolic steroids and marijuana, or occupational exposure to chemicals such as pesticides and heavy metals, can all lead to impaired sperm function and reduced sperm quality.

Sedentary lifestyles, high calorie fast foods and being overweight have been clearly linked to impaired sperm production and affect fertility.  A physically active lifestyle, keeping weight in healthy range, balanced and healthy diet including plenty of fresh fruits and vegetables, a natural source of antioxidants and

minerals which have been found to result in better quality sperm; are all important components in optimising male fertility.

The testes hang outside the body for a reason.  Avoiding tight underwear, long hot bath or sauna, or even prolong sitting which may raise the scrotal temperature (a degree Celsius below core temperature) to optimise the environment for sperm production.

Regular sex, not exceeding every 2-3 days especially prior to ovulation will be ideal, as long periods of abstinence can decrease the quality of sperm.  It is more important to ensure that the first portion of the semen rich in sperm are ejaculated inside the vagina, regardless of position during intercourse, absence or presence of orgasm; it is not necessary to have prolonged rest after intercourse to avoid later part of ejaculate to leak out.  Some commercial lubricants and other substances used for lubrication may contain chemicals unfavourable for sperm function, if needed choose those prepared for fertility use.

Although men don’t have a ‘biological clock’ like women and remain fertile and continue to produce sperm into old age, issues like erectile dysfunction and lower libido associated with aging may contribute indirectly to subfertility. Moreover, the qualities of a man’s semen may deteriorate as he ages especially beyond 40-50 years including the quality of sperm DNA that may increase their partner’s risk of pregnancy complications and their baby’s risk of genetic abnormalities.

Current techniques assist sperm to fertilise the egg

Previous treatments for male infertility have tried to change semen parameters using medical or surgical means but these treatments were generally ineffective (see table below)).

 

Attempts to improve sperm concentration, morphology and motility have not been very successful because the majority of semen defects/variants are constitutional problems or under cryptic genetic control. They are therefore not particularly amenable to manipulation, except for situations such as reversing a vasectomy or medically/surgically correcting factors such as hormone deficiencies, infections or exposure to toxins.

The development of IVF and intracytoplasmic sperm injection (ICSI) revolutionised the treatment of male infertility by directly assisting the sperm to fertilise the egg, which cannot be achieved efficiently in nature when semen defects are present.

Treatment success & health of children

Sperm DNA fragmentation is an important cause of infertility and determinant of treatment success and health of children

Another important cause of male infertility is sperm DNA fragmentation which can result from oxidative damage secondary to cigarette smoking, concurrent infections/ill-health or increasing age. If DNA in the sperm is not well packed, then it can be easily damaged when sperm leave the protective environment of the testes and begin travelling through the epididymis (a track 4-5 meters long).

Sperm DNA fragmentation should be assessed if couples have a history of multiple unsuccessful IVF cycles despite the availability of embryos for transfer.

Treatment options

Treatment options for men with high levels of sperm DNA fragmentation can include increasing antioxidant levels through dietary changes or nutritional supplements and addressing other factors such as cigarette smoking or infections. Shortening the sperm transit time by frequent ejaculation can help reduce sperm DNA fragmentation.

Another option is to obtain sperm directly from the testes via a testicular sperm needle aspiration before they are damaged during their transit down the epididymis. Alternatively, for some undamaged sperm can be selected for fertilisation using specific sperm washing and selection techniques, such as PICSI. The latter involves placing sperm on a hyaluronic acid-coated petri dish. Hyaluronic acid is part of the gel layer surrounding the oocyte, so only mature and biochemically competent sperm bind to the petri dish. These healthy sperm have lower levels of aneuploidy and DNA damage, and can be selected for subsequent ICSI.

Genetic screening becomes more important

The ability to bypass natural selection processes in men with infertility through the use of new assisted conception techniques brings with it great responsibility. Normally, infertile men would be unable to reproduce, so if we are helping these couples to conceive, it is important to offer genetic screening to ensure that we are not passing on genetic disorders to the offspring. Preimplantation genetic diagnosis (PGD) allows embryos to be tested on day 5 for the presence of chromosomal translocations and genetic diseases such as cystic fibrosis that can be associated with abnormal sperm parameters.

Key message

Many male factors can be overcome

It is important to remember that we can overcome many of the male factors for infertility. Treatments for male infertility have changed dramatically with the availability of IVF and ICSI which allow us to help with the process of fertilisation. However, these advances in the treatment of male infertility need to be accompanied by procedures that minimise the risk of passing genetic disorders to the offspring.

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