Male infertility: Current concepts, causes and management (3)
Some of the drugs used in treating include aromatase inhibitors like Anastrozole and cyclic steroids (for immune suppression). It is important to note that these drugs can be combined to get better results. The clinician has to identify the underlying causes and appropriate medication to use.
What we find most successful is to use these medications in a sequence, not together. For instance, many people use testosterone medications, such as Proviron, daily for several months. Unfortunately, in men, the physiological levels of testosterone are not constant but pulsatile. It is the same with many other hormones, hence the need to prescribe them in a pulsatile fashion for good results.
In general, a comprehensive review showed that two significant items could help to improve the sperm DNA fragments, count and structure. They are Co-Enzyme Q 10 (CoQ10 200mg twice daily) and Omega 3 (200-500mg daily). The two act together to improve the mitochondria activities of the sperm. Some hormones prescribed by medical specialists can also help the sperm
Modification of lifestyle: Patients should be encouraged to stop smoking cigarettes and psychoactive substances. Relief from stress, weight loss, dietary modification and avoidance of toxins have all been shown to be beneficial in the treatment of male infertility.
Body Detox: Many people are exposed to toxins from the environment, preservatives in food, drugs, cosmetics and stress. These toxins may accumulate in vital organs, leading to organ damage and infertility. Total body medical detoxification in a medical spa helps to remove these toxins, thereby improving fertility.
Surgical procedures that can help to enhance male infertility include the following:
Vasovasostomy/ Vasoepididymostomy: These are surgeries done to reverse vasectomies. A vasectomy is a form of permanent birth control whereby the vas-deferens are cut and sealed off to prevent the flow of sperm into the urethra. Pregnancy rates for these procedures vary between 20-70% with vasovasostomy having a higher success rate.
Varicocelectomy: This is a surgical procedure for the treatment of male infertility. Varicoceles are abnormally dilated testicular veins found in the scrotum. They can cause decreased sperm production and quality, which may lead to infertility. They are universal and occur in 15 percent of the general male population. This procedure involves clamping off the abnormal veins, so blood flow is restricted to only healthy veins.
Assisted reproductive technology
This refers to the use of advanced techniques to achieve conception. These techniques will not cure or treat the cause of infertility, but they can help couples achieve a pregnancy. We use the following:
Artificial Insemination/Fallopian Tube Sperm Perfusion:Patients with mild, even moderate oligozoospermia, can benefit from this non-invasive treatment. It involves the direct intrauterine injection of ‘sperm suspension’ usually after adequate sperm processing (washing). The aim is to achieve higher concentrations of sperm in the ‘fallopian tubes’ to facilitate conception. Pregnancy rates are about 20 per cent per trial and multiple births are common when combined with super-ovulation.
Intra-cytoplasmic sperm injection: This is for patients with severe oligozoospermia. It involves the direct injection of sperm into the oocyte (egg). For this to be done, the oocytes have to be retrieved from the female partner, while the semen is collected from the male partner and processed. This method has been extremely beneficial for patients with deficient sperm concentrations. Globally, pregnancy rates are between 35 per cent and 45 per cent and they can go up to 60 per cent with multiple trials.
Advanced sperm retrieval techniques: Several procedures can be used to collect sperm in patients with azoospermia using local anaesthesia. Many patients with absence of sperm in their semen may have some sperm in their testis (organ containing sperm) and epididymis (the organ that stores mature sperm). Specific procedures can be used to obtain sperm directly from these organs with the help of special needles. These procedures include:
TESA (Testicular Sperm Aspiration): using local anaesthesia
PESA (Percutaneous Epididymal Sperm Aspiration)
TESE (Testicular Sperm Extraction)
Micro-TESE (Microscopic-Testicular Sperm Extraction)
Microsurgical epididymal sperm aspiration
The first two are less invasive than the last two. They all involve the direct collection of sperm from the testis and epididymis, and they have been used successfully for men with azoospermia. We have reported many pregnancies and babies born through these techniques. Recently, in a patient with azoospermia, we were able to identify a single sperm after searching under the microscope for more than one hour. It resulted in one embryo and current ongoing pregnancy.
In conclusion, treatment exists for oligozoospermia and azoospermia. The type and extent of treatment can only be determined after proper evaluation and testing by a skilled fertility physician using appropriate techniques and procedures.