Treatment of male infertility

If the semen analysis shows impaired parameters, adjusting the lifestyle may help (reducing smoking and drinking alcohol, reducing excessive physical stress, trying to prevent an increase in testicular temperature, including vitamin supplements, especially vitamins E and C into the diet). It is important to realize that the effect on sperm quality will be seen in about three months (the approximate time of sperm maturation).

 
If the cause of a man’s infertility can be diagnosed, hormonal, antibiotic or surgical treatment can be started. In the case of retrograde ejaculation (ejaculation into the bladder), which cannot be remedied by medication, sperm for artificial fertilization can be obtained from the urine.
If no sperm is present in the semen (azoospermia), it is possible to obtain sperm by surgical collection.
 
If the transport of sperm from the epididymis to the urethra fails, sperm can be obtained by using the MESA technique (microsurgical epididymal sperm aspiration).
 
If the transport of sperm to the epididymis fails, we opt for the TESE technique (testicular sperm extraction), in which a small piece of germinal epithelium is removed. The removed tissue is then processed in the laboratory. If live sperm is obtained, it can be used for fertilization using the ICSI technique.
 
If the sperm cannot be obtained in this way, it is possible to fertilize the partner’s eggs with the sperm of a donor.
 
Assisted reproduction
If a pregnancy does not take place even after male infertility treatment, one of the assisted reproduction methods may be suggested to you. If the man is diagnosed with normospermia or a slight decrease in some of the key parameters of sperm analysis, the physician may recommend the couple undergo intrauterine insemination (IUI). This procedure is carried out especially in cases where sperm are not able to individually penetrate the cervix into the uterus (to detect this a postcoital test – PCT is used).
 
If for some reason the partner’s eggs cannot be fertilized by the sperm, there is a possibility of assisted intrauterine insemination (AIUI) for which donor’s sperm is used. Intrauterine insemination is recommended to be performed a maximum of 3 to 4 times, and if the method is not effective, the doctor usually recommends in vitro fertilization (IVF).
 
If the values of sperm analysis and post-coital test are normal and yet the couple cannot conceive spontaneously, the doctor usually  recommends the classical method of fertilization (joint co-incubation of gametes in a small space in a special medium).
 
If the man was diagnosed with a low sperm count, low motility or morphology, the classic IVF may not be effective. In these cases it is suitable to use the ICSI method (Intracytoplasmic Sperm Injection), in which the embryologist selects one suitable sperm and inserts it into an egg.
 
An alternative to this method is the PICSI method, which can be recommended to you if there is a lot of sperm with fragmented DNA in the ejaculate. In this method, the embryologist selects the sperm according to the visual assessment and their functional quality.
 
Another option for selecting sperm suitable for eggs’ fertilization is  the IMSI method.

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