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A. management of male infertility depends on the cause.
Obstructive azoospermia is a situation when there is lack of spermatozoa in semen and post-ejaculate urine as a result of obstruction. The volume of semen may be smaller.
The path of the sperm cells can be obstructed in several places:
The most common causes of obstruction are infections (for example, gonorrhoea, chlamydia, prostatitis, tuberculosis), birth defects (congenital disorders), or trauma to the genitalia.
Treatment depends on the amount of obstruction. Semen can be collected by biopsy from the testicle or the epididymis.
Surgery on the vas deferens can restore the pathway.
Cystic fibrosis (CF) is associated with CF mutations. These men might lack the vas deferens on both sides. This means that sperm cells cannot mix with the ejaculate, so the ejaculate will not include any sperm (azoospermia).
To achieve pregnancy, sperm must be collected directly from the testicles or epididymis by a biopsy.
In the case of CF as the cause of male infertility, the female partner should also be genetically tested for CF. Two carrier parents have a 50% chance of having a child with CF (carrier means that there is a gene defect on one chromosome, from one parent and there are no symptoms of a disease. In CF there should be a gene defect on mother’s and father’s chromosome for a child to suffer from CF).
Vasectomy is a surgical procedure of cutting the vas deferens and stopping the spermatozoa flow in the vas deferens to make the man infertile. This procedure is permanent and is considered irreversible.
In some cases, it can be reversed, but the chance of success depends on when the vasectomy has taken place.
It is a common disease of enlarged veins above the testes that drain blood from the testes. Enlarged veins cause that the testicle is overheated and sperm production may be negatively affected. If you have varicocele and pain or infertility or hypogonadism a specialist in Urology may offer you varicocelectomy (surgical repair of varicocele).
A normal level of testosterone is needed for optimal sperm production in the testes.
It is the absence of one or both testes in the scrotum. It is the most common genetic abnormality of male genitalia.
At one year of age nearly 1% of all full-term male children have cryptorchidism. The majority of undescended tests are corrected in early childhood and in adolescence.
When you are adult, a specialist in Urology will examine your testes, hormones and semen and will take individual decision whether to treat it. Treatment is surgical.
Infections of male urogenital tract are curable causes of male infertility.
A urology / andrology specialist may examine your semen, swabs or culture and prescribe medication.
It is a common cancer in men aged 15-40 years, and affects 1% of infertile men. Cancer causes decreased semen quality.
Semen cryopreservation before orchidectomy is recommended.
Treatment of cancer may cause further decrease in semen quality and decrease in testosterone production. A urologist will offer a life-long follow up for this men.
Microcalcifications can be found inside the testes in up to 9% men having ultrasound of the scrotum for any reason. They are common in men with cancer, cryptorchidism, infertility, hypogonadism and varicocele.
Your Urologist will offer a follow up and, in some patients, may offer a testicular biopsy if you have calcifications and any other problem mentioned above.
A self-examination is also recommended for these men.
In some cases, the ejaculate cannot reach the urethra. The man might not be able to ejaculate, it might be delayed, or the semen might go into the bladder (retrograde ejaculation).
Causes can be psychological, physical (for example, nervous system dysfunction after surgery or trauma), or related to medication use.
Treatment options include medication and physical stimulation.
Sometimes, semen must be collected for fertility treatment.
Several procedures are used, depending on the problem.
If none of the procedures are an option for you, semen from donors can be used to achieve pregnancy.
However, regulations regarding sperm donation vary.
Cryopreservation is the storage of biological material at sub-zero temperatures [e.g., – 80 or -196°C].
Cryopreservation is used to postpone cell ageing and cell death. This process stops cell metabolism by freezing.
The semen sample is collected in a sterile container. The cryopreservation process starts immediately after the sample is made. When the sample is needed, the sample is thawed in a water bath at 37 degrees Celsius for 10 minutes. Not all semen samples survive thawing.