Understanding Male Infertility Treatment
With male infertility, the problem can either be one of insufficient sperm production, or a blockage in the male reproductive tract that is preventing the sperm from reaching the ejaculate.
Dr. Werthman uses multiple treatment procedures to treat male infertility, depending on the exact circumstances of your particular case. To understand these procedures and how they work, you will need to understand basic male reproductive physiology, and how fertility is evaluated.
Male Reproductive Physiology
The testicles, located outside the body due to heat sensitivity, have two basic functions. They produce testosterone and sperm. The inside of the testicle is made up of millions of hollow seminiferous tubules. Their walls are comprised of reproductive cells in various stages of development.
Sperm production starts with a large, round immature cell, the spermatogonia, that divides and undergoes a multi-step, 72-day maturation process, until it becomes a sperm cell, with a head and a tail.
Sperm are released and enter the epididymis, where they are stored. During ejaculation, the sperm are brought up through the vas deferens and prostate, where they mix with seminal vesicle fluid to form semen.
No Sperm in the Ejaculate: Azoospermia
Normally, the seminiferous tubules produce millions of sperm. In the abnormal testicle, sperm may be found in small amounts in some of the tubules.
Azoospermia, or the condition of no sperm in the ejaculate, is due to either a blockage in the reproductive tract or a deficiency in sperm production.
Sperm harvesting techniques have been designed to address these different scenarios based on the patient’s condition.
Male Infertility Treatments
After a diagnosis is made, Dr. Werthman will recommend a treatment plan to help you and your partner improve your chances for successful pregnancy. Testing will be needed to ascertain whether your fertility difficulty is caused by a lack of sperm production, or a blockage, and to see if it is possible to use treatments with hormone therapy to increase your sperm production.
In most cases of male infertility, the diagnosis and treatment will likely involve removing sperm from the reproductive tract to use with In Vitro Fertilization (IVF) and/or Intra-Cytoplasmic Sperm Injection (ICSI). (In ICSI, a single sperm is injected directly into the egg.)
Micro-surgical sperm harvesting techniques have been designed to address different scenarios based on your particular situation. The techniques that Dr. Werthman uses were developed at CMRM to give the best possible results in the most comfortable ways possible.
Micro TESE: Microsurgical Testicular Sperm Extraction
If the problem is insufficient sperm production, then it is necessary for Dr. Werthman to extract sperm directly from the testicles. For this Dr. Werthman generally recommends a Micro TESE for the best possible results.
A varicocele is an enlargement of the veins that drain the scrotum, similar to varicose veins that people get in their legs. Repairing the varicocele is an effective technique to improve testicular function and sperm production in men with azoospermia and varicoceles.
MESA: Microsurgical Epididymal Sperm Aspiration
When infertility is caused by a blockage, sperm can be removed from the epididymis. At CMRM, we developed this in-office, relatively painless procedure.
Four distinct techniques are available for Sperm Aspiration, or harvesting sperm from men who are infertile. Learn which procedures Dr. Werthman recommends, which he advises patients to avoid, and why.