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Examination and treatment of male fertility disorders - andrology
Male fertility disorders are responsible for about 1/3 of cases of infertile couples and, according to many studies, that percentage has been rising dramatically. Some authors report that the sperm concentration levels have decreased by up to 40 million/ml in last 50 years. These alarming facts lead to the development of andrology as an inherent part of assisted reproduction. The co-operation with urologists, geneticists and sexuologists is important for the examinations and treatment.
List of examinations:
1. Basic examination
2. Spermiogram, pH test, biochemical examination of the seminal fluid
3. Sperm morphology assessment
4. Hormonal examination
5. Cultivation test
6. Interaction between sperm and ovular fluid
7. Examination of antibodies against sperm
8. Examinations for varicocele
9. Genetic examination
10. Testicle biopsy
Possibilities of treatment
1. Elimination of risk factors (fever, harmful substances, stress)
2. Polyvitamin treatment, trace elements
3. Treatment of infection
4. Possibilities of hormonal therapy
5. Surgical repair of the varicocele and obstruction
6. Sexuological therapy
7. Suppression of antispermatozoidal antibodies
8. Assisted reproduction
What can offer assisted reproduction ?
Assisted reproduction methods are the most effective treatment of the male and female infertility or their combinations. The choice of the optimum technique is determined by a rational course of examinations and treatments of the infertile couple.
1. Artificial insemination
The essence of artificial insemination is the deposition of seminal fluid within the female genitals by other means than a sexual intercourse. The basic preconditions for a successful AI are salphinx patency and performing the AI when spontaneous or stimulated ovulation has been detected. Various methods can be used:
a) Intravaginal, intracervical insemination
These methods are suitable in cases when infertility is due to the inability to perform a sexual intercourse because of, e.g., an abnormal penis anatomy, or a sexual dysfunction. Spermiogram values, however, must be within standard limits. The sperm is not treated in any way, and it is deposited into the back vaginal vault or into the cervix without at the time of ovulation monitored by e.g. ultrasound folliculometry.
b) Intrauterine Insemination - IUI
The intrauterine insemination improves the chances of impregnation in the case of pathological spermiogram values. For intrauterine insemination, it is necessary to treat the sperm before it can be used. In our clinic, we prefer the salphinx perfusion technique. In that procedure, the sperm are suspended in 1 ml cultivation medium. After the suspension has been deposited into the uterus, the sperms penetrate into fallopian tubes and the immediately vicinity of the ovaries.
2. IVF
This method is considered the golden standard for oocytes fertilization outside the female organism. You will find more information about this technique in the chapter on extracorporeal oocytes fertilization.
3. ICSI
The method is based on a direct injection of one sperm into the cytoplasm of a mature oocyte. You will find more details about this method in the chapter on extracorporeal oocyte fertilization.
4. MESA/TESE
In cases when there are no spermatozoa in the semen (azoospermia), it is possible to get some from the epididymis (MESA = micro-epididymal sperm aspiration) or from the seminiferous ducts of the testicle (TESE = testicular sperm extraction). The operation is performed under a total anaesthesia with the assistance of an urologist after an internal and urological examination. Couples undergoing this treatment may stay at our clinic in special rooms.
When do we suggest to use sperm from a donor?
The present successful development of assisted reproduction methods in the treatment of male infertility has markedly limited the need to use sperm from donors, which remains to be indicated in the case of genetically linked diseases or a failure of the above methods of assisted reproduction. The donor's sperm may be used for the intrauterine insemination, IVF or ICSI. In principle, frozen sperm of thoroughly tested donors is used
From the legal point of view, use of the donor's sperm is permissible only in married couples. A consent of both the husband and the wife authenticated by a notary public is essential. An optimum donor is chosen according to a detailed questionnaire on the appearance and the wishes of the spouses. You will be asked to hand in the completed questionnaire at the embryological laboratory or at ward rounds a day before the operation at the latest. We strictly uphold all ethical, legislative and technical aspects of the procedure.
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