Causes of male infertility
As the characteristics of sperm for normal fertilization are well known, any abnormal results from the sperm tests (spermogram) suggest a problem on the male side.
Clinics specialized in ART have also used in vitro fertilization (IVF) as a diagnostic test. Very often, the fertilization of a healthy ovum in the laboratory cannot be carried out due to the abnormal functioning of the spermatozoids. Therefore, failure with IVF can give more conclusive evidence that the sterility is on the male side.
The spermogram is the most frequently used test to assess male infertility and can reveal the following abnormalities:
Oligospermia:Low sperm count
Hypospermia:insufficient semen production which can be due to a testicular defect or obstruction
Azoospermia: the absence of spermatozoids, normally at least 20 million spermatozoids are produced per ml of semen; less than this is considered abnormal
Asthenozoospermia: little mobility; generally less than 30% of the spermatozoids are mobile. If this happens, the spermatozoids cannot move through the neck of the uterus to meet with the ovum in the Fallopian tube
Teratozoospermia:abnormal morphology. This condition prevents the spermatozoid from penetrating the external layers of the ovum due to its abnormal form.
Sperm abnormalities are not the only cause of male infertility. Problems can be connected to intercourse, perhaps through dysfunctional ejaculation or impotence.
Recent studies have revealed that a high number of couples suffer from immunological sterility which is the rejection of the sperm by the woman’s system. Another cause of male infertility is varicocele which is the enlargement of the spermatic veins in the scrotum.
Treatment
Currently, even though the most difficult causes of male infertility are likely to be treated using ART, including the most serious cases for which a few years ago the only solution was artificial insemination using donor sperm or adoption, successful treatment has been achieved using new techniques in ICSI. Another alternative for men with azoospermia is the vacuuming of the epididyme or doing a biopsy of the testicle to obtain spermatozoids.
When a man suffers from a known disorder such as hypogonadotropic hypogonadism (the inability of the testicles to produce spermatozoids), a hormone substitution treatment can be given to stimulate the testicles. These reproductive hormones are known as gonadotropins and can also be given to women to stimulate egg production.
Microinjection techniques:
Over the last few years, intra cytoplasmic sperm injection techniques (ICSI) have represented an important innovation and have finally given a viable treatment for even the most difficult male infertility cases. Before, adoption was the only option offered by doctors. Now, ICSI offers a real therapeutic solution.
ICSI is carried out using the most sophisticated microscopes and instruments for handling microscopic elements. For example, embryologists can hold a human egg on the tip of a fine suction pipette and penetrate it with a needle seven times finer than a hair. In normal conception, a single ejaculation can contain more than 200 million viable spermatozoids, however, only a couple of hundred will reach the ovum that was released in the Fallopian tube and have an opportunity to fertilize it.
Oocyte before being injected:
Oocyte in the injected:
Now with 10 spermatozoids and ICSI, there is real hope for men with this problem.
Current global statistics show that 70% of the ova injected are fertilized. ICSI is particularly recommended for couples where the cause of infertility is male and when IVF cycles have failed.
It is important to mention the theoretical risk of transmitting hereditary illnesses such as Cystic Fibrosis or the same cause of infertility to male babies.
