Male Infertility Tests and Treatments

The first step in any infertility treatment

A 30 – 60 minute initial consultation is your first step in any infertility treatment plan, regardless of which specific treatments you may require.

During your initial consultation at Medfem Fertility Clinic, a highly qualified and experienced fertility specialist will:

* do an extensive review of your medical history
* perform a comprehensive infertility physical exam and blood tests
* provide in-depth explanations and answers to all your questions
* detail a broad range of infertility treatment options
* develop with you a personalised fertility treatment plan that fits you best.

Below are detailed the male infertility tests proudly offered at Medfem Fertility Clinic and the male infertility treatments which may be included in your treatment plan, depending on your unique circumstances.

Male Infertility Tests

Male infertility may be caused by the sperm, the testes themselves, the ducts that lead out from the testes, a functional problem in relation to sexual activity, hormonal issues or genetic problems. However, most causes of male infertility are usually related to sperm disorders – in fact, damage to sperm production affects two thirds of men who are experiencing fertility challenges.

As such, male infertility tests determine the quantity and quality of male sperm.

Fertility is adversely affected if sperm are not being produced in adequate numbers, or are obstructed from reaching the penis, or are not swimming well, or if they are being attacked by antibodies from either the male himself or his female partner. In addition, the balance of hormones that allow sperm development and support, are tested.

Semen Analysis

A semen analysis measures the amount of semen produced and determines the number and quality of sperm in the semen sample. A semen analysis is usually one of the first tests done to help determine whether a man has infertility problems.

Tests that may be done during a semen analysis include:

Volume: This is a measure of how much semen is present in one ejaculation.

Liquefaction time: This is a measure of the time it takes for semen to liquefy from a thick gel at the time of ejaculation – normally within 20 minutes after ejaculation.

Sperm count: This is a count of the number of sperm present per milliliter of semen in one ejaculation.

Sperm morphology: This is a measure of the percentage of sperm that have a normal shape.

Sperm motility: This is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of semen can also be measured (motile density).

pH: This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen.

White blood cell count: White blood cells are not normally present in semen.

Fructose level: This is a measure of the amount of a sugar called fructose in the semen. The fructose provides energy for the sperm.

Ultrasound

An ultrasound examination of the testes and prostate can be a useful diagnostic test. An ultrasound probe is placed on the testicles to provide a picture of the testes and epididymis. It is also useful for diagnosing testicular cancer and varicocele.

Testicular Biopsy

A testicular biopsy involves the removal of a small sample of the tissue from a testicle. This allows for direct inspection of the sperm-making tissue.

Male Fertility Treatments, Procedures and Options

* Hormonal Therapy
* Varicocele Repair
* Vasectomy Reversal
* Surgical Sperm Retrieval
* Testicular Sperm Aspiration (TESA)
* Percutaneous Epididymal Sperm Aspiration (PESA)
* Microsurgical Epididymal Sperm Aspiration (MESA)
* Testicular Sperm Extraction (TESE)
* ICSI
* Artificial / Intrauterine Insemination
* Sperm Donation
* Sperm freezing and storage

Hormonal Therapy

A deficiency in the hormones that control testicular function causes male hormonal disorder. These imbalances are successfully treated by injections of hormone preparations called gonadotrophins. These hormone treatments cause the testes to increase in size and produce testosterone in normal amounts. Sperm should appear in the semen after several months of treatment.

Varicocele Repair

A varicocele is a dilation of the veins of the scrotum which may interfere with the testicle’s production of sperm. During a varicocele repair, the veins are tied or clipped through a small incision in the groin. Within a few months of the procedure, most men achieve a significant improvement in sperm production.

Vasectomy Reversal

A vasectomy reversal repairs a surgically removed section of the sperm duct and is called a vasovasostomy. Around eight weeks after surgery, semen analysis are done to note improvements in sperm count and motility. The results of a vasectomy reversal depend on how long ago the procedure was done. If 10 years or more have passed since the vasectomy, the chance of having sperm reappearing in the semen is greatly reduced.

Surgical sperm retrieval

There are rare cases of male infertility in which normal sperm production or sperm ejaculation is prevented by an obstruction in the complicated tubal system of the testes. In these cases, provided that motile sperm are being produced, it is possible to retrieve sperm through surgical sperm retrieval which uses a very fine needle to extract sperm directly from the epididymis or the testes. Alternatively, if no live sperms are found, a sample of tissue (testicular biopsy) can be taken from the testes and examined under a microscope for sperm cells.

Provided that one or two sperm cells can be surgically retrieved by any of these methods, fertilisation is possible using the microinjection technique of Intracytoplasmic Sperm Injection (ICSI).

These techniques have proven a revolution in the treatment of men with very severe infertility – now surgical sperm retrieval of just a few sperm cells from the testes and the technique of ICSI makes fatherhood possible for the most challenging of cases.

Testicular Sperm Aspiration (TESA)

In this procedure, a fine needle is passed through the skin of the scrotum into a testicle to extract sperm tissue. This is usually performed a number of times in different parts of the testes until an area with reasonable sperm production is found. Sperm are then retrieved from the tissue.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a simple technique to obtain sperm in men who have an obstruction of the sperm duct – either due to a previous vasectomy or some other obstruction. PESA involves inserting a needle attached to a syringe into the epididymis and then gently extracting sperm-containing fluid.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA involves opening up the ducts of the epididymis and extracting fluid or a piece of testicular tissue in order to extract live sperm rather than just extracting fluid through a fine needle as is done with PESA. MESA is usually only done when PESA has been unsuccessful.

Testicular Sperm Extraction (TESE)

TESE is performed when there is an absence of sperm in the epididymis or if there is no epididymis. It involves making a small incision and removing a piece of testicular tissue to obtain sperm.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) is a procedure in which sperm are directly injected into the egg, used in the case of poor semen characteristics.

ICSI can be seen as one of the major break throughs in treatment of male infertility, since only a few normal sperm are needed and because of its rate of fertilisation of around 70%. Men who were previously seen as completely sterile now have an excellent chance to have their own child.

ICSI is usually offered to couples who have had poor or no fertilisation during standard IVF, or when fertilisation is less likely to occur with routine IVF. To date, tens of thousands of children have been born around the world as the result of ICSI.

Artificial Insemination (AI) / Intrauterine Insemination (IUI)

This is the technique of placing sperm from a male partner or from a sperm donor directly into the female partner’s uterus. It is sometimes used in cases where the male partner has a mild sperm abnormality or anti-sperm antibodies.

Sperm Donation

Medfem Fertility Clinic founded its own sperm bank in 1990 to address the acute donor sperm shortage in South Africa and since then many couples, single women and same-sex couples have started and expanded their families. Our aim is to give couples and women maximum choice when selecting donor sperm for their fertility needs. Our sperm donors are decent and committed men who give up their time, without getting paid, to donate their sperm to help others to conceive.

Sperm Freezing and Storage

This is the process of freezing and storing semen samples so you and your partner may use them to become pregnant in the future. There are many situations that could interfere with your future fertility, such as radiation or chemo therapy, pelvic or testicular surgery, vasectomy and certain illnesses, diseases or injuries.

The success rates of using stored sperm vary and depend on several factors. First, your health or underlying illness may affect the quality of the sperm at the time they are frozen. Second, approximately 60% of the sperm frozen will survive the freezing and thawing process. Third, the success rates will depend on your female partner’s age, fertility status, and the method of assisted reproduction that is used.

The first step in any male infertility treatment

The first step in any male infertility treatment – contacting a fertility clinic to set up your initial consultation – is never easy.
However, you could view this as a progressive and positive step in uncovering what your infertility problems might be, receiving professional treatment, and ultimately achieving a pregnancy with your partner.

Also remember that you are not alone – infertility affects one in six couples of reproductive age. So, whether you are recently concerned about your fertility or looking for guidance, we will do our best to help you find the right path.

A first consultation is necessary before any treatment begins. You will meet one of our four specialists, who will discuss your medical history, conduct a comprehensive infertility work up, advise you of your options, and start to plan your treatments.

Simply click here or contact us on +27 (11) 463 2244 to book your initial consultation and take your first step to parenthood.