Male Fertility

This term applies when the male partner is either the sole or a contributing cause of infertile couples. A detailed sperm analysis is used to evaluate the male partner and can determine the concentration (amount), motility (movement) and morphology (shape) of the sperm.

The cause of abnormal sperm can be:

• Varicocele (dilated or varicose veins in the scrotum)
• Duct obstruction
• Hormonal
• Infectious

Additional testing including blood, semen cultures, and a comprehensive examination by a urologist can help identify the cause.

A semen analysis is the primary diagnostic testing method used to evaluate male fertility. The male patient provides a semen sample, usually through self-stimulation. The semen sample must be collected in a sterile container and brought to the lab within an hour of collection. Once in the lab, the semen will be evaluated for sperm count, motility, shape, pH levels, concentration, and vitality.

Before providing sample for semen analysis, men must abstain from all sexual activities, including intercourse and masturbation, for two to seven days. The abstaining period helps to ensure that the semen analysis will be as accurate as possible.

Treatment for male factor infertility may include:

• Surgical correction of a varicocele or duct obstruction
• Hormonal medications to improve sperm production
• Antibiotic therapy for infection

In many cases, no direct treatment for decreased sperm counts is effective. In those instances, IVF with intracytoplasmic sperm injection (ICSI) may be recommended.

Male factor infertility can result in a variety of issues such as complete absence of sperm in the ejaculate (azoospermia) due to either an obstruction/blockage (obstructive azoospermia) often caused by a previous vasectomy or congenital-birth defects. For these conditions, a surgical option can retrieve sperm from either the vas deferens, epididymis or testis for use in an IVF cycle(s) to conceive. Because the surgically retrieved sperm are immature, fertilization is achieved by injecting selected sperm directly into the egg by a process called intracytoplasmic sperm injection (ICSI).

Males considering this option are required to see a urologist prior to surgery to help determine the best approach for retrieving sperm including:

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA collects sperm by aspirating fluid from the epididymis of the male reproductive tract. A fine needle is inserted through the scrotum into the epididymis and sperm are obtained by gentle suction. This procedure is used for cases of obstructive azoospermia.

Testicular Sperm Aspiration (TESA)

TESA is where a fine needle is inserted into the testis, a sample of tissue is obtained by gentle suction and then examined under the microscope. If sperm are not found, a small tissue sample (testicular biopsy) is taken through a small incision in the scrotum and testis, where sperm can then be extracted. This procedure is used for cases of non-obstructive azoospermia.

 If possible, MESA and TESA procedures are timed to coincide with the egg retrieval step during the IVF cycle. For some, scheduling may be an issue. Surgical sperm retrieval can be completed before the IVF cycle begins and frozen (cryopreserved) for future use. The extraction of sperm completed by MESA and TESA typically results in enough sperm to allow several IVF cycles. These procedures can be performed on an outpatient basis using sedation to eliminate any pain or discomfort. At Tennessee Fertility Institute, we perform mirosurgical sperm aspiration, but do not perform the TESA procedure. We will refer the patient to a urologist.