What is male infertility?
Male infertility is a lowering of a male's sperm count or sperm quality sufficient to reduce a couple's chance of pregnancy. A patient is usually said to have male infertility if the sperm count is less than 20 million per ml, the motility is less than 50 percent or the percentage of normally shaped sperm is less than 30 percent.

Are male infertility and male sterility the same?
No. Male sterility refers to the complete absence of sperm production by the testicles and, thus, the complete absence of the possibility of pregnancy. Male infertility refers to a reduced, but not a complete absence of sperm, and thus the possibility of pregnancy exits. However, without medical assistance the chance of pregnancy per cycle is very low.

What forms of treatment are available for male infertility?
Treatment for male factor infertility vary from intrauterine insemination (IUI) to in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Individualized treatment protocols are provided by the physician after the diagnostic evaluation is completed. If the female partner is 35-39 years of age, the male will usually be treated with advanced infertility therapies more quickly because the chance of pregnancy decreases rapidly from age 35-39. Women 40 years of age and older need to progress rapidly to advanced therapies so as not to waste precious time on treatments with a lower chance of success.

I have heard a lot about a treatment for male infertility called ICSI? What is it?
Severe male-factor infertility is treated very successfully by a laboratory technique called ICSI. ICSI involves injecting one sperm directly into the egg using a microscope with specialized micromanipulation equipment. ICSI is always used in conjunction with in vitro fertilization (IVF).

What is oligospermia?
The term "oligo" means few. Oligospermia is the presence of fewer than the normal number of sperm in the semen. Men with fewer than 20 million sperm/ml are usally defined as having oligospermia, or a low sperm count.

What is azoospermia?
Azoospermia is the complete lack of sperm in the ejaculate.

Are there different types of azoospermia?
Yes. There are two different types of azoospermia. Obstructive azoospermia is the complete lack of sperm in the ejaculate due to a blockage in the male reproductive tract or the absence of the part of the reproductive tract that carries sperm from the testicle to outside the body. A blockage, or obstruction, may have been present at birth or may have occurred as a result of an infection or severe trauma to the testicles or the tubules surrounding the testicles that transport the sperm out of the body. Men with obstructive azoospermia almost always have some sperm in their testicles, but these sperm are not found in the semen because of the blockage or absence of part of the reproductive tract.

Men who undergo a vasectomy for contraceptive purposes have obstructive azoospermia. If pregnancy is later desired, a surgical procedure called a vasectomy reversal can be attempted to remove the blockage in the vas deferens. If the vasectomy reversal is not successful, sperm aspiration techniques can be used in conjunction with IVF-ICSI to treat the male's obstructive azoospermia.

Nonobstructive azoospermia is the lack of sperm in the ejaculate due to a very low production, or no production of sperm in the testicles. About 50 percent of men with nonobstructive azoospermia have some sperm production in one or both testicles.

Are there any treatments for azoospermia?
Yes. There are several highly effective treatments for azoospermia. As long as a few sperm are being produced in one or both testicles, pregnancy is possible using sperm-aspiration techniques. These techniques involve aspirating sperm from the epididymis, the tubule that carries sperm from the testicle to outside the body, or from the testicle, the male organ that produces sperm.

For treating obstructive azoospermia, a procedure called Percutaneous Sperm Aspiration, or PESA, is used to aspirate sperm from the epididymis. Sperm are located in the epididymis close to the testicle, before the blockage or obstruction in the reproductive tract. PESA is usually performed on the same day as the female partner's IVF egg retrieval. The PESA procedure is performed by an urologist with fellowship training in treating male infertility. The PESA procedure usually requires 10-20 minutes to complete. Intravenous sedation is given for patient comfort. The patient recovers for 1-2 hours in a private recovery room at Arizona Associates for Reproductive Health. Patients may return to work the next day usually with little or no discomfort. The sperm obtained from PESA are injected into the female partner's eggs using the ICSI technique described above. Because only one sperm is required per egg with ICSI and many motile sperm are usually retrieved with PESA, usually some sperm remain following the ICSI procedure. This sperm is frozen for use in future egg retrieval cycles in case the couple does not conceive in the first cycle or wishes to have additional children in the future. Freezing the extra sperm from PESA is important because it allows for several attempts at IVF with only one sperm aspiration on the male partner.

For treating nonobstructive azoospermia, a procedure called Testicular Sperm Extraction, or TESE, is used to obtain sperm directly from the testicle, where the sperm are being produced. The TESE procedure involves the removal of very small pieces of testicular tissue. This tissue is given to the IVF laboratory for dissection and identification of sperm. The TESE procedure is performed by an urologist with experience in the treatment of male infertility. The procedure usually requires 10-20 minutes to complete and is done under intravenous sedation for patient comfort. Recovery is similar to the PESA procedure.

Sperm are obtained in about one-half of patients with nonobstructive azoospermia. The remainder of the patients will have no sperm or too few sperm in their testicles to allow for sperm identification in the removed tissue. In most cases, if sperm are found in the testicular tissue, there will be enough present to inject all of the female partner's eggs and some sperm will remain after ICSI for freezing. In a few cases, the sperm count will be insufficient to inject all eggs or no sperm will remain after ICSI to freeze for use in future cycles.

Because only one-half of the patients with nonobstructive azoospermia have sperm identified at the time of TESE, it is recommended that these men undergo a diagnostic TESE procedure prior to the procedure to stimulate the female partner to produce eggs for IVF. During diagnostic TESE, tissue is sent to the IVF laboratory. If sperm are found, they are frozen and the female partner may then begin stimulation for IVF. On the day of the female partner's egg retrieval, the sperm are thawed and used in conjunction with ICSI to fertilize the eggs. If sperm are not found at diagnostic TESE, the couple may then consider other options, such as donor sperm or adoption.