Treatments for male factor infertility will be influenced by at least three important factors:

1. Cause of infertility, if identifiable

2. Severity of the sperm defect

3. Age of the female partner

Varicocele: If a varicocele is found, sometimes surgery to ligate (tie off) the abnormally dilated veins is recommended. If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing the infertility treatment surgery will see some improvement in the sperm quality. The reported pregnancy rates following surgery are in the range of 40%, but most pregnancies occur 6-9 months following surgery, so age of the female partner needs to be a major consideration. If the initial sperm count and motility are in the severe male factor category, it is unlikely that this surgery will improve sperm counts enough to enable the couple to conceive without assistance.

Unexplained low sperm count: If there is a mild decrease in the sperm count or motility, the urologist may prescribe Clomiphene citrate, an infertility pill commonly used to treat women who fail to ovulate. Clomiphene (also called Clomid or Serophene) mildly stimulates the pituitary to make hormones that stimulate sperm production. Sperm counts should be re-analyzed 3-6 months after initiation of the medication to evaluate the effectiveness of this infertility treatment. Again, if the sperm count is very poor to begin with, this strategy is less likely to be successful. As always, the female partner should be considered, as the time necessary to give these infertility treatments a chance to work depends on how much time she has.

Mild male factor, unexplained cause: Enhanced sperm are placed directly into the uterine cavity via intrauterine insemination (IUI), thus eliminating their passage through the vagina and cervix. For more information on IUI, click here.

A recent study suggests that the pregnancy success rates following IUI , in cases of mild male factor or unexplained infertility , are approximately 5% per insemination cycle. This rate can be improved to about 9% per cycle if the female partner is induced to "super-ovulate" with injectable infertility treatment medications , such as Gonal-F. It is important to note that the average age of female patients in the study was 32.4 years of age. Rates for success would likely decrease as age increases.

Moderate to severe male factor, unexplained cause: Generally, good fertilization rates can be achieved through in vitro fertilization (IVF) with intra-cytoplasmic sperm injection (ICSI) , which is the injection of a single live sperm directly into the egg.

Most authorities consider IUI to be ineffective in cases of severe male infertility. The ideal infertility treatment, when surgical and medical management fails to improve sperm function, is in vitro fertilization and embryo transfer (IVF/ET), usually accompanied by Intra-cytoplasmic sperm injection (ICSI). Please click here for more information on ICSI, or visit our IVF Tour.

Prior Vasectomy: If you have had a vasectomy, we generally advise you to undergo one of two procedures to help you and your partner achieve a pregnancy: a vasectomy reversal or IVF-ICSI infertility treatment with epididymal or testicular sperm extraction. The age of your female partner and the length of time since your prior vasectomy are important factors in making your decision. It can sometimes take 6-9 months to recover adequate sperm counts following vasectomy reversal. Also, the greater the length of time between the vasectomy and the reversal, the greater the chances are that the surgery will be unsuccessful or that anti-sperm antibodies will form, preventing the recovered sperm from penetrating the eggs without IVF-ICSI infertility treatment. Any man undergoing vasectomy reversal should request that any vasal sperm seen at the time of the reversal be frozen in case subsequent scarring and re-obstruction occurs.

Prior Vasectomy or Congenital Absence of the Vas Deferens (Obstructive Azoospermia): If you have had a prior vasectomy or have been diagnosed with congenital absence of the vas deferens (i.e. no sperm in the ejaculate, but normal testicular sperm production), our infertility doctors usually recommend IVF-ICSI infertility treatment with either Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE).

A MESA procedure is performed under local anesthesia and general sedation . The first incision is made in the scrotum, exposing the epididymus ( the tubules immediately adjacent to the testicles that collect the sperm ). Using an operating microscope, another incision is made on these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if your female partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.

A TESE or testicular sperm extraction is an infertility treatment procedure that involves directly aspirating the sperm from the testes or obtaining sperm from a testicular biopsy. It is usually performed under local anesthesia and can be done in the office. The disadvantage is that in many cases, testicular sperm are scarce and difficult to freeze. Usually, there is only enough sperm recovered during the TESE procedure for one case of IVF and if further IVF attempts are needed, the procedure needs to be repeated.

Non-obstructive Azoospermia: Men with very poor sperm production in the testicles and no sperm in the ejaculate often demonstrate high blood FSH levels and , at times, low testosterone levels. Small testicles and testicular failure are also common. TESE, or testicular biopsy infertility treatment, are usually the only option s for non-obstructive azoospermia, as there are no sperm in the epididymus and even testicular sperm production can be "patchy" and scarce within the testes. Men with this diagnosis , who have been told they have no sperm on routine testicular biopsies, can be found to have sperm present in scattered distribution within the testicle upon further investigation . If this is the case, areas with sperm can be re-aspirated for IVF-ICSI with some degree of success, depending on the amount of sperm obtained.

Sertoli Cell Only Syndrome:The c omplete absence of sperm progenitor cells and the a bsence of spermatogenesis occur as a result of this rare condition. Sperm donation and/or adoption are the only options in this particular case .