It must be remembered that the testis have two distinct roles.
The first is to produce the male sex hormone, testosterone, which is important for providing sex drive, erections, strong muscles and and in part giving a man a general feeling of well being. All these things can be described as virility.
The second function of the testis is to produce millions of sperm everyday, a process that occurs inside each testis. The time it takes for a sperm to mature in the testes and be ready to fertilise an egg is 2 ½ -3 months. For most infertile men it is only this process that is problematic and a reduced number or poor quality of sperm are produced. Identifying a cause for an abnormal semen analysis can be challenging and improving sperm production takes 3-6 months minimum.
Most abnormal semen analyses show low numbers of sperm (count), but many also show both poor swimming ability (motility) and abnormally shape (morphology). In such men, only a small number of normally shaped motile sperm are likely to swim up the woman’s fallopian tube into the vicinity of the egg and even then may be unable to fertilise the egg.
Why does this problem develop? We know the cause may be medical, genetic, environmental or structural such as previous trauma to the testicles. The best first step is to speak to a fertility specialist who will review your family, medical, surgical and behavioral history. Lifestyle factors and medications can impact sperm production. Smoking, obesity and exposure to heat are clearly linked to low sperm numbers. Eating a healthy diet and avoiding toxic habits are important. Steroid use such as testosterone can prevent the brain from telling the testes to make sperm. Stopping these medications could allow the body to recover sperm production but this may take a lot of time. Being aware of what factors are modifiable will allow help, but your partner’s timeline may be shorter than the time it takes for sperm production to recover. If the cause is found to be genetic, there is no direct method to improve fertility naturally however IVF techniques offer hope as they require fewer normal sperm than nature.
Structural problems in the testes include surgery such as a vasectomy, but any history of injury, and other trauma or sexually transmitted disease may be important. Men produce antibodies to their sperm following vasectomy, trauma or infection. These antibodies are a common cause of infertility and prevent sperm swimming or sticking to the egg. ICSI is a treatment that can over-come this issue and is available Cayman Fertility Center.
Some men have difficulties obtaining an erection or ejaculating due to a wide range of conditions such as diabetes, multiple sclerosis, or previous prostate surgery. In these cases sperm can be found in the testes and used for IVF.
Rarely, a deficiency in the brain pituitary hormones may result in low sperm counts. Its detection is important as it is readily treated with hormones.
Finally studies have shown that sperm counts have declined worldwide. The reported change is quite small (about 15%) and no cause has been confidently identified, however it is believed to be an environmental factor.
In conclusion while the causes of infertility are uncertain in many men, certain conditions can be identified and treated. Given these facts, it is essential that all men suffering with infertility undergo testing to determine the cause and the best course of treatment.
There are two common approaches to testicular biopsy:
- PESA: This is when a fine needle is inserted into the tubes that convey the sperm out of the testis. One area of this tubing, the epididymus, is a natural reservoir for sperm and is therefore a good place to aspirate them from.
- TESE: If a PESA is not possible or no sperm are identified then the fall back procedure is a testicular biopsy or TESE. This procedure involves the removal of very small pieces of tissue from the testis. The Embryologist then processes the biopsies with a view to finding motile sperm.
The testicular biopsy procedures are performed under local anesthetic. The procedure takes about 15 minutes.
Sperm suitable for ICSI are sometimes not found. It is prudent, therefore, to have some form of sperm as “back-up” in order that the ICSI treatment cycles not have to be abandoned.
The sperm recovered by either of these techniques is only suitable for use with ICSI. Once the ICSI has been completed and sperm remaining, of good quality, may be frozen for use with future ICSI cycles.
The success rate for ICSI is typically 30 – 55% at CFC per treatment cycle. However, the success rate is dependent on many factors, such as the age of the woman.