Male infertility treatments

The treatment for male infertility depends upon its underlying cause.

Blockage of the reproductive tract

If the man has a blockage in the ducts that carry the sperm, he can have surgery to correct it. Another option is assisted reproductive techniques using sperm retrieved directly from the testes (see below).

Vasectomy (male sterilisation) is a specific type of blockage. Vasectomies can be reversed in up to 85 per cent of cases, but the more time that has passed since the vasectomy, the less likely it will be that fertility can be restored.

Hypothalamic or pituitary deficiency

In a small percentage of cases, male infertility is due to problems in the hypothalamus and pituitary gland (parts of the brain that regulate hormone production). In this case, the man would be offered hormone treatment. Most men will eventually develop sperm in the ejaculate, although it might take one to two years of treatment to achieve normal fertility.

Varicocele

A varicocele is a dilated vein in the scrotum. Many men with varicocele have a low sperm count or abnormal sperm shape. The reason a varicocele affects the sperm may be related to a higher than normal temperature in the testicles, poor oxygen supply, and poor blood flow in the testicles.

Varicocele can be treated surgically, but surgery does not always improve fertility and is not recommended for most men unless the varicocele is large. An alternative to varicocele repair, and the recommended approach, is assisted reproductive techniques, usually intracytoplasmic sperm injection.

Assisted reproductive techniques

If the semen has a low sperm count, no sperm, abnormal sperm, or sperm with poor motility (movement), assisted reproductive techniques often help. For some infertile couples this will be the only way to achieve a pregnancy.

Testicular biopsy

If there is no sperm in the ejaculate (azoospermia), it can sometimes be directly retrieved from the testicles. You would normally have a local anaesthetic and a small needle is used. You might also need minor surgery, which would involve a cut in the scrotum. If sperm is found, it will be used for ICSI. The fertilisation rate for this procedure is similar to IVF.

Sperm harvesting using this technique is straightforward, with a small risk of bruising, bleeding and infection.

There is some evidence that children of couples who become pregnant after IVF or ICSI have a slightly higher rate of birth abnormalities, although these conditions are rare and the overall risk of having a child with a birth anomaly is low. If you are in this situation, your fertility specialist should discuss this potential risk with you.

When male infertility cannot be treated

Couples affected by non-treatable male infertility may consider artificial insemination using donor sperm. Donor sperm may be obtained from a sperm bank, which screens men for infections and certain genetic problems, and provides a detailed personal and family profile.

The decision to use donor sperm (from a known or unknown donor) can be complicated and difficult. Counselling may be helpful and is highly recommended.

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