Treatment

Male Infertility

Male Infertility Treatments and Technology

Treatment will depend on the results of diagnostic tests.

Non-invasive treatments

In men with alterations in sperm motility and concentration without apparent cause, lifestyle changes, including weight loss, increased physical activity, and reduced alcohol and tobacco intake can help improve semen quality and increase the chances of conception.

Although moderate alcohol consumption does not seem to affect gonadal function, the consumption of large amounts of alcohol (more than 2 alcoholic beverages per day) does have a negative impact on testosterone levels, which is restored after cessation of alcohol intake.
Also, the use of vitamin complexes and antioxidants can improve semen parameters.

Hormonal treatments

Hormone replacement therapy will be used in cases of hypogonadotropic hypogonadism (secondary hypogonadism), including congenital causes.

Congenital causes should be treated with a combination of human chorionic gonadotropin (hCG) and follicle stimulating hormone (FSH) or pulsed gonadotropin-releasing hormone (GnRH) by pump therapy to stimulate spermatogenesis.

Testosterone therapy should never be used for the treatment of male infertility.

Varicocele treatment

Varicocele (dilatation of the veins that drain into the testicle) is a cause of fertility impairment in the male.

It is necessary to treat it in the following cases:

• Varicocele in adolescents with reduced testicular volume and evidence of progressive testicular dysfunction.
• Infertile men with a clinical varicocele, abnormal seminal parameters and otherwise infertility to improve fertility rates.

It is not recommended to treat varicocele in infertile men who have a normal semen analysis and in men with a subclinical varicocele.

Microsurgical varicocelectomy is the technique of choice and may also be considered in men with high DNA fragmentation and unexplained infertility or who have experienced failure of assisted reproductive techniques including recurrent pregnancy loss, embryogenesis and implantation failure.

At ROC Clinic, we perform microsurgical varicocelectomy, which through a minimal incision on the pubis allows us to section the dilated veins that are causing the condition. The use of the microscope, in addition to allowing a more accurate evaluation of the structures, reduces the possible complications of the procedure and has shown to have the best resolution rates of varicocele and improvement of semen quality.

Invasive treatments 

Obstetric azoospermia

It is the least common form of azoospermia, occurring in 20-40% of the total. It is usually in men with normal FSH, normal sized testes and enlargement of the epididymis. The deferens may be absent unilaterally or bilaterally, and obstruction may occur at various levels (intratesticular, epididymal, deferential, ejaculatory ducts).

The treatment will be essentially surgical, trying to diagnose the level of obstruction and, if possible, solving it. If this is not possible, the next step would be to obtain spermatozoa for assisted reproductive therapy.

Non-obstructive azoospermia

It is defined by the absence of spermatozoa with a normal ejaculate volume in the seminogram, which must be repeated on at least 2 occasions. The cause may be a problem in the hypothalamic-pituitary-gonadal axis or a testicular disease. It is essential to always try to look for the cause of the disease.

The best treatment option is the detection and collection of live sperm directly from the testicles. This treatment is part of assisted reproductive therapies.

Assisted reproduction techniques

There are several steps involved in completing an assisted reproduction cycle. First, the woman is pharmacologically stimulated to produce multiple ovarian follicles, while the menstrual cycle is inhibited. When these follicles have reached the appropriate level of development, medication is administered to mature the eggs, which are then selected and extracted. After obtaining the genetic material from the man, fertilization is performed by IVF (in vitro fertilization) or ICSI. Subsequently, the embryos are implanted in the uterus after deciding the best time for the embryos to be implanted in the endometrium.

There are several assisted reproduction techniques:

• Intrauterine insemination. The partner's or donor's sperm is administered directly into the uterus, after having stimulated ovulation or not, at the optimal moment of the menstrual cycle. Adequate semen quality and a woman under 40 years of age are necessary for the chances of success to be favorable.
• In vitro fertilization. Ovarian stimulation is performed, and the eggs are stored by means of an echo-guided puncture. The eggs, once processed, are united with the man's sperm, and the result is incubated for 2-3 days in culture, and the resulting embryos are subsequently implanted intrautero.
• Intracytoplasmic sperm injection (ICSI) Injection of a single sperm directly into the egg is performed. The difference between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is the method used to achieve fertilization. While in IVF the oocytes are mixed with semen in a Petri dish and fertilized naturally, in ICSI a selected sperm is injected through a micropipette. It is currently the most widely used assisted reproduction technique.