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Today, there have been made many exciting advances concerning male infertility. Male infertility can be caused by low sperm count, erectile dysfunction and spinal cord injury. We have new techniques to deal with these problems.
For the diagnosis process, men must receive an evaluation including a fertility history, physical exam, blood testing, and semen analysis. In semen analysis, the sperm microscopically examined to determine the sperm count (number of sperm per cubic millimeter), motility (movement), and morphology (shape and size of sperm).
If there are no sperm cells in the ejaculation due to blockage or testicular abnormalities, onsite minimal surgical procedures are conducted. This may include the following procedures:
Testicular Biopsy
Testicular Biopsy may be helpful to determine the cause of male infertility. The procedure involves microscopically examining a tissue sample that contains seminiferous tubules that produce sperm. The results may indicate correctable problems with the testis. If the testis is normal, there must be other sources for the infertility. During the procedure, the patient is under local anesthesia.
Microsurgical Sperm Aspiration (MESA and TESE)
These are two procedures used to retrieve sperm directly from different areas of the testicle. Both procedures are performed under local anesthesia. The sperm can then be used in conjunction with IVF and Intracytoplasmic Sperm Injection (ICSI). Generally, these procedures are used when the man has had a vasectomy, when there have been unsuccessful reversals, when there is an absence of vas deferens, or when there is epididymal scarring. Even if there is little or no sperm found in the epididymal tubules, or when there is no epididymis, the procedure will still work. The testicular sperm can be obtained and injected directly into the egg through the ICSI procedure.
Microsurgical Epididymal Sperm Aspiration (MESA)
This method is used when infertility is caused by blockage. Using an operating microscope, reproductive specialists isolate the epididymis and then retrieve fluid from an epididymal tubule. The fluid obtained is then processed in the laboratory to ensure that sperm is present. Afterwards, the tubules are closed microsurgically. The sperm can then be used immediately or frozen for later use. After a MESA, further invasive procedures are not necessary during future attempts at pregnancy.
Testicular Sperm Extraction (TESE)
This method involves removing a small piece of testicular tissue through an incision in the testes. The tissue is then processed to extract sperm in the laboratory. As opposed to MESA, this process usually results in fewer specimens since they are more difficult to work with and do not freeze as well as. TESE is only used in severe cases where it is the only method to deal with poor sperm.
At New Hope Fertility Dr. Sherman Silber takes care of male patients with severe infertility problems. Please call Peter Fuzesi at 212-400-9624 to schedule an appointment for Dr. Silber.
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