Treatment for Male Factor

Treatment of Male Factor Infertility

The treatment of male factor infertility is directed towards treating reversible causes, halting damaging factors, (and assisting in advanced reproductive techniques).
Varicoceles, dilated veins around the testicles, are the most common cause of male subfertility.   It is a relatively minor operation to tie them off or excise them.  The success rate following treatment results in improvement in seminal parameters in up to 70 % of men, with a 35-40 % unassisted pregnancy rate.
Men who have a blockage of the vas deferens (ducts conveying the sperm from the testis to the penis) can undergo surgery to correct the blockage. If it is not successful, another option is IVF using sperm retrieved from the testes. If even a small number of sperm are produced they may be collected and injected into an egg during in vitro fertilisation (intracytoplasmic sperm injection or ICSI)
Vasectomy (male sterilization) is a different type of blockage. Vasectomies can be reversed in up to 85 % of cases; over 50 % of couples can achieve pregnancy following vasectomy reversal. However, the more time that has passed since the vasectomy, the less likely vasectomy reversal is to restore fertility.
Treatment of hypothalamic or pituitary deficiency — In a small percentage of cases (1 to 2%), male infertility is due to problems in the hypothalamus and pituitary gland (parts of the brain that regulate hormone production). In this case, treatment with human chorionic gonadotropin (hCG), recombinant human follicle stimulating hormone (rhFSH) (also called gonadotropin treatment) is often given.

Treatment is not currently available for most types of male infertility. For example, there is no known treatment when the sperm-producing structures of the testes have been severely damaged or are abnormal. This happens in men with certain chromosomal abnormalities such as Klinefelter syndrome.

Some treatments for male infertility fail, and some cases of male infertility simply cannot be treated at this time. If this is this case, an infertility specialist can advise the couple of available alternatives. Each couple's choice is a very personal one.
Men with irreversible infertility and testosterone deficiency may benefit from testosterone treatment. Although this treatment may not address a couple's goal of having a child, it can improve the male partner's sexual function and mood and help increase and maintain bone and muscle mass
Artificial insemination with donor sperm — Some couples affected by irreversible male infertility consider artificial insemination of the female partner with donor sperm. Donor sperm may be obtained from a sperm bank, which screens men for infections, certain genetic problems, and provides a complete personal and family history. Most sperm banks keep the identity of their donors confidential.  The UK law permits the offspring to know the identity of the donor on reaching the age of 18.
The decision to use donor sperm, whether from a known or unknown donor, can be complicated and difficult for a couple. Counselling may be helpful to help both partners discuss their feelings and the potential implications of using donor sperm. The use of donor sperm has a high success rate; pregnancy rates are about 50 percent after six cycles of insemination. Insemination may be done without the use of infertility medications or monitoring in women who have no infertility. Women who have difficulty conceiving may require intrauterine insemination or in vitro fertilization.
Adoption — Some couples affected by irreversible male infertility consider adopting a child. A healthcare provider or social worker can suggest resources for couples who decide to pursue this option. Approximately 2 to 4 % of American families include an adopted child.
Childlessness — Some couples affected by irreversible male infertility decide to remain childless. Parents who decide to remain childless often face questions from friends or family regarding their decision. These questions can be hurtful for couples who have struggled with infertility. Couples often benefit from counselling after they decide to stop infertility treatments; communicating openly is important to maintain a healthy relationship.

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