in this issue
Sonja Kristiansen, MD
Medical Director & co-founder
of
the
Infertility Center
of Houston, Dr. Kristiansen is double board certified in
Reproductive
Endocrinology and Obstetrics & Gynecology and
specializes in surgical and IVF procedures.
She has
advanced training in hysteroscopy, laparoscopy, and
microtubal reconstruction. She also works with
female endocrine abnormalities relating to
menstrual and reproductive development.
Quick Links...
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Greetings,
Men can feel particularly sensitive about utilizing the
services of a fertility expert. The good news is that
male factor infertility can often be relatively easier to
treat than female factors.
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Medical Treatments
Therapy in the form of medicine has as its goal the
significant improvement of sperm cell quality and
quantity. Medicines used include therapeutic level
hormones and antioxidants. If evidence of infection is
found in either the urinary tract, testes, or prostate,
relatively common antibiotics may be used with the
goal of clearing the infection and enhancing sperm
production, health, and transport.
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Surgical & Other Treatments
Depending on the diagnosis, other options for
treating male infertility are:
- Vasectomy reversal
- Varicocele ligation
- Microsurgical repair of obstructions
- Electroejaculation
- Several methods of sperm retrieval, both surgical
and needle-aspiration
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
The
purpose of male reproductive surgery, in general, is
to clear the way for sperm transport from where the
cells are produced (the testes) through several
different sections of tube to their final destination.
Blockages from several causes can occur at any point
in the sperm cell's journey. Depending on the location
of the blockage, the result can be not only reduced
sperm count, but more importantly, sperm cells that do
not function normally.
Consumers should understand that sperm count is not
nearly as important as other parameters, notably
motility (movement of the cells) and morphology (cell
shape.) While I generally recommend IUI for couples in
which the male partner has 10 to 20 million total normal
sperm and IVF/ICSI for those with less than 10 million,
each patient's situation must be closely and thoroughly
examined to determine the most efficient and
appropriate treatment plan. For example, when there is
an adequate sperm count but a majority of the
spermatazoa have motility and/or morphology problems,
IVF/ICSI will be the desired route because only a few
normal sperm are needed for success. In these cases,
using IUI's to combat motility/morphology problems
would be less likely to result in conception.In cases of
ejaculatory duct obstruction, some
blockages can be repaired through a transurethral
procedure. Advances in microsurgical techniques mean
that surgeries such as vasectomy reversal, varicocele
(dilated testicular veins) repair, and obstruction
reversal of the vas deferens or epididymis can be
accomplished successfully and with less recovery
period or pain.
All aspects of surgery versus IVF should be considered
when making treatment decisions. For example, reports
in both the Journal of the American Medical Association
and the Lancet indicate that while varicocelectomy is
still being performed often, this particular male surgery
has not been proven to actually improve pregnancy
rates.
Some of the very techniques that are used to diagnose
male factors can also be used in treatment. Different
sperm aspiration techniques can obtain sperm cells so
that even men who have azoospermia (that is, they
have no sperm cells in their ejaculate) may have their
cells analyzed. Similarly, sperm retrieved by aspiration
can be used in the in vitro fertilization (IVF) process for
conception. The technological miracle of
intracytoplasmic sperm injection (ICSI) relies on the
use of individual sperm cells to be injected into egg
cells. ICSI is done only in conjunction with IVF.
For some couples, the use of donor sperm provides the
answers to their family-building needs.
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Results
Success rates for each treatment vary. Individual
patient factors like age and health play a role in that
success. There is often debate about whether or not a
couple is better off going straight to IVF or whether
they will benefit more from correcting the initial
problems, such as sperm obstructions, first. Since each
patient's need is different, we avoid making blanket
statements that one route is better than another. We'll
discuss how the details apply to each patient's
situation with the patient and his partner in privacy.
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In Closing
As always, I and my staff are available to answer any
questions you may have regarding male infertility and
other related issues.
Sincerely,
Sonja B. Kristiansen, MD
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