How Is Male Infertility Treated?
Men with infertility problems should first adopt a healthier lifestyle. Reducing or ideally quitting smoking, avoiding tight underwear, and refraining from prolonged inactivity are among the most important steps.
For men who have difficulty maintaining healthy eating habits or quitting smoking, vitamin E supplementation may be recommended. In addition, avoiding tight underwear and long periods of immobility is also important.
Today, the main approach focuses not so much on treating male infertility itself, but rather on utilizing the existing sperm. If the total motile sperm count is between 5 and 10 million, intrauterine insemination (IUI) may be applied. The success rate of this method is approximately 10%, and after three attempts, 2–3 out of every 10 couples may achieve pregnancy. However, performing more than three insemination attempts is not recommended, as further attempts are generally not effective in case of failure.
The most effective treatment methods for male infertility are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In infertile couples, the woman’s age and ovarian reserve are important factors that determine the success rate of treatment. If the woman is young and has an adequate ovarian reserve, the chance of pregnancy with IVF or ICSI can reach up to 60%.
In cases of azoospermia, surgical sperm retrieval is usually performed on the day of egg collection. In some cases, sperm may be frozen after retrieval and thawed on the day of egg collection. Most sperm retrieval procedures are performed under local anesthesia by urologists specialized in andrology and do not require hospitalization. These procedures generally last 30–45 minutes.
All procedures are performed in an IVF center, and the collected samples are simultaneously examined by embryologists in the laboratory. Once sperm is found, the procedure is terminated. In obstructive azoospermia, the sperm retrieval rate is close to 100%, whereas in non-obstructive azoospermia, it is approximately 50–55%. After freeze–thaw procedures, there is sometimes a risk that no viable, motile sperm will be obtained. Surgical sperm retrieval methods are explained below.
PESA (Percutaneous Epididymal Sperm Aspiration) Method:
This method involves aspirating sperm from the epididymis, located above the testes, using a fine needle. It is generally used in cases of obstructive azoospermia. If sperm cannot be obtained with this method, other testicular sperm retrieval techniques are considered.
TESA (Percutaneous Testicular Sperm Aspiration) Method:
In this procedure, a fine needle is inserted through the skin into the testicular tissue without opening the scrotum to obtain a sample. If sperm cannot be obtained with this method, the next step is the micro-TESE procedure.
Micro-TESE (Microsurgical Testicular Sperm Extraction) Method:
Micro-TESE takes into account that sperm production may be present in patchy areas within the testis. Using microscopic magnification allows detailed examination of seminiferous tubules and increases the likelihood of finding sperm. This method is more advantageous than conventional TESE because smaller tissue samples are taken, reducing the risk of damage to testicular tissue.
During the procedure:
The testis is opened with a small incision
Testicular tissue is examined under a microscope
Very small tissue samples, about the size of a grain of rice, are taken from fuller-looking tubules
Innovations in the Treatment of Male Infertility
STEM CELLS
Stem cells are the source of all cells in our body. They are primitive cells capable of differentiating into all types of cells and tissues. In men with no sperm in their semen, if mature sperm cannot be found during surgical sperm retrieval procedures, stem cell therapy may be considered. Differentiation of cells obtained from other tissues has been successfully achieved in laboratory settings, leading to the formation of sperm or sperm-like structures.
IMSI
IMSI enables better sperm selection in IVF treatment. Scientific evidence suggests that selecting sperm under very high magnification for use in microinjection can result in higher fertilization and pregnancy rates in cases of severe male infertility. The benefits of IMSI have also been demonstrated in couples with male infertility and recurrent IVF failure.
MICROFLUIDIC CHIPS (MICROCHIPS)
This technique has certain advantages over other sperm selection methods. With the help of microfluidic chips, healthier sperm can be selected during current insemination and IVF procedures.