Male Infertility Treatment

Treatment of male infertility is most successful when it is directed towards treating specific problems.  For instance, varicoceles (varicose veins of the testicles noted to cause overheating and resultant fertility compromise seen in the semen analysis) are present in up to 60 % of men presenting for male infertility treatment.  A relatively minor day surgery procedure of the groin area performed under anesthesia corrects the varicoceles in 98 % of Dr. Buch’s cases.   Semen analysis parameters improve significantly in 66 % of those cases, and the pregnancy rate increases to near normal levels of 75-85 % pregnancy per year in the improved group.

When there are no sperm present in the ejaculate, a condition called azoospermia, then the cause is either a failure to produce the sperm or the result of an obstruction of the sperm ducts.  In the case of obstruction, these are either correctable by surgery, or uncorrectable blockages.  In cases of obstruction of the epididymis, the sperm duct leading directly out from the testicle, a minor outpatient microsurgery in the scrotal sac can result in return of sperm in 85 % of our cases.  This success rate is only achieved by microsurgeons with extensive experience.  In up to 50 % of cases of sperm production failure (non-obstructive azoospermia or NOA) that do not respond to varicocele repair or hormone therapy, we can obtain a few fragile sperm from open testicular biopsy (TESE) that can then be injected inside the wife’s eggs in the laboratory in a process called in-vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI). 

Obviously, our preference is to find a specific condition that can be treated with medication.  Three such specific conditions are hypogonadism (an abnormal hormone profile including low testosterone level), sperm antibodies (an abnormal immune reaction against one’s own sperm resulting in poor sperm movement), and sperm duct infections such as epididymitis or prostatitis.  In such cases, medication can result in a 50 % or higher success rate.  However, even when there is not a specific problem to treat, many men with low sperm count will respond to empiric treatment with the hormone pills tamoxifen or clomiphene.

There have not been enough rigorous and positive scientific studies done to suggest that the use of vitamin pills or making clothing or life style changes will help with two exceptions.  Men who have varicoceles may be more prone to further negative effects on sperm from cigarette smoking, and chronic extensive use of sauna or hot tubs may also decrease sperm count.

When medication and surgery have been used, but the semen parameters are still not sufficient for natural conception, then intra-uterine insemination (IUI) and in-vitro fertilization with intracytoplasmic injection (IVF-ICSI) can be used by high level female fertility specialists called reproductive endocrinologists.  In this day and age, most couples will be able to conceive with some level of medical assistance.