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Contents 6
How Is Male Infertility Treated?
Men experiencing infertility should first adopt a healthier lifestyle. Reducing or, if possible, quitting smoking, avoiding tight-fitting underwear, and avoiding prolonged periods of inactivity are among the most important steps.
Vitamin E supplementation may be recommended for men who have difficulty adopting healthy eating habits or quitting smoking. In addition, avoiding tight underwear and prolonged inactivity is also important.
Today, the main approach generally focuses on making use of the sperm that is available, rather than treating the male infertility itself. If the total motile sperm count is between 5 and 10 million, insemination may be applied. This method has a success rate of around 10%, and after three attempts, 2-3 out of every 10 couples can achieve pregnancy. However, more than three insemination attempts are not recommended, as further attempts are generally not effective after repeated failure.
The most effective treatment methods for male infertility are IVF and microinjection (ICSI). In couples experiencing infertility, 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 microinjection treatment can reach up to 60%.
In cases of azoospermia, surgical sperm retrieval is generally performed on the day of egg collection. In some cases, the retrieved sperm is frozen and thawed on the day of egg collection instead. Most sperm retrieval methods are performed under local anesthesia by urologists specializing in andrology and do not require hospitalization. The procedures generally take 30-45 minutes.
All procedures are carried out at the IVF center, and the samples obtained are examined simultaneously in the laboratory by embryologists. The procedure is stopped as soon as sperm is found. In obstructive azoospermia, the sperm retrieval rate is around 100%, whereas in non-obstructive azoospermia it may be around 50-55%. After the freeze-thaw process, there is sometimes a risk that no live, motile sperm will be found. The surgical sperm retrieval methods are described below.
PESA (Percutaneous Epididymal Sperm Aspiration) Method:
This method involves retrieving sperm from the epididymis, located above the testicles, using a fine needle. It is generally used in cases of obstructive azoospermia. If sperm cannot be obtained by this method, other testicular sperm retrieval methods are used instead.
TESA (Percutaneous Testicular Sperm Aspiration) Method:
Without opening the testicular sac, a sample is taken by entering the testicular tissue through the skin with a fine needle. If sperm cannot be obtained by this method, the next step is micro-TESE.
Micro-TESE (Microsurgical Testicular Sperm Extraction) Method:
Given that sperm production may occur in patchy areas within the testicle, micro-TESE allows the tubules to be examined under microscope magnification, increasing the likelihood of finding sperm. This method is advantageous compared to classic TESE because the tissue removed is smaller, reducing the risk of damage to the testicular tissue.
During the procedure;
A small incision is made in the testicle
The testicular tissue is examined under the microscope
Very small, rice-grain-sized tissue samples are taken from tubules that appear full
Innovations in the Treatment of Male-Factor Infertility
STEM CELLS
Stem cells are the source of all the cells in our body. They are primitive cells capable of forming all the cell types and tissues in the body. In men who have no sperm at all in their semen, if no mature sperm is found during surgical sperm retrieval, stem cell therapy may be attempted. Differentiation of cells taken from other tissues has also been achieved in laboratory settings, producing sperm or sperm-like structures.
IMSI
IMSI allows for better sperm selection in IVF treatment. Scientific data suggest that selecting sperm for microinjection under high magnification can achieve higher fertilization and pregnancy rates in cases of severe male infertility. The benefit of IMSI treatment has also been demonstrated in couples with male infertility and recurrent IVF failure.
MICROFLUIDIC CHIPS (MICROCHIP)
This technique offers certain advantages over other sperm selection techniques. Sperm selection using microfluidic chips helps identify healthy sperm during insemination and IVF procedures that are already in use.