male infertility treatment

Last reviewed 06/2022

All risk factors should be identified and tackled, such as:

  • reduction of smoking and drinking
  • suggested measures include avoidance of saunas, hot baths, the wearing of tight underwear, and other situations in which scrotal temperature may be raised
  • if a varicocoele is present previously ligation of the offending veins was undertaken to try and improve semen quality - however a systematic review states that there is no evidence that treatment of varicoceles in men from couples with otherwise unexplained subfertility improves the couple's chance of conception (1). NICE also advise against the effectiveness of treatment of varicoeles in the improvement of fertility (2)
  • any infection should be treated

Low semen volume may produce insufficient contact with the cervical mucus for adequate sperm migration, and may be overcome by artificial insemination with the partner's semen.

High semen volume but low sperm numbers may be overcome by concentrating the semen - collection of a "split ejaculate" is often useful, as frequently, most of the sperm are present in the first part of the ejaculate.

Oligospermia may respond to treatments such as clomiphene or interferon - although this condition is now not a hurdle to successful in-vitro fertilisation

  • clomiphene citrate is a well-established agent that has been described to empirically treat idiopathic oligospermia (3)
    • clomiphene citrate increases pituitary secretion by blocking the feedback inhibition of estradiol, thus increasing serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, with the latter gonadotropin stimulating the testicular synthesis of testosterone

Azoospermia due to mechanical blockage may respond to an epididymovasostomy. There is a 50% success rate provided that underlying spermatogenesis is normal.

When semen quality cannot be improved, intrauterine insemination timed to coincide with ovulation may be successful. This technique may also be effective in cases of infertility associated with female sperm antibodies as the cervical mucus is the main source of such antibodies.

In-vitro fertilisation with sperm from men with oligospermia or abnormal morphology may be undertaken with ICSI (intracytoplasmic sperm injection). Testicular sperm extraction (TESE)/ICSI currently represents the treatment of choice for male infertility resulting from non-obstructive azoospermia (4)

  • testicular sperm retrieval is a feasible and successful procedure
    • among surgical techniques testicular sperm extraction (TESE) and microsurgical epididymial sperm aspiration (MESA) have become the most popular techniques
    • testicular spermatozoa can be retrieved from the testis in up to 70% of patients, even in cases with testicular azoospermia and severe disorders of spermatogenesis. However, surgical damage of the testis might also compromise the interstitial compartment of the testis with testosterone deficiency as a consequence

Artificial insemination with donor sperm may be considered if the patients with azoospermia where TESE is not possible.

NICE suggest that (2):

  • with respect to tight underwear
    • men should be informed that there is an association between elevated scrotal temperature and reduced semen quality, but that it is uncertain whether wearing loose-fitting underwear improves fertility
  • Medical management:
    • men with hypogonadotrophic hypogonadism should be offered gonadotrophin drugs because these are effective in improving fertility
  • Surgical management (male factor infertility)
    • where appropriate expertise is available, men with obstructive azoospermia should be offered surgical correction of epididymal blockage because it is likely to restore patency of the duct and improve fertility. Surgical correction should be considered as an alternative to surgical sperm recovery and IVF
    • men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates
  • Management of ejaculatory failure
    • treatment of ejaculatory failure can restore fertility without the need for invasive methods of sperm retrieval or the use of assisted reproduction procedures. However, further evaluation of different treatment options is needed

Reference:

Related pages:

infertility

intracytoplasmic sperm injection

birth defects in infants conceived by ICSI

varicocoele