This is Blog #5 in our S.P.E.R.M Blog series for National Fertility Awareness Week 2023
Management options are available for most issues highlighted by a semen analysis. Treatment depends on the underlying cause, which can range from problems with sperm production to the testicles' ability to transport sperm to the ejaculate.
In some situations where no obvious problem has been identified - known as “unexplained infertility” - evidence-based treatments that improve fertility may be recommended.
Treatments for male infertility include:
#1 - Surgery
To correct or repair anatomical abnormalities or damage to male reproductive organs. For example, a varicocele (where veins become enlarged inside the scrotum) can often be surgically corrected, or an obstructed vas deferens (tube transporting sperm to the ejaculatory duct) repaired, to help improve sperm counts. If a man has had a vasectomy, there may be a chance to repair this too. In cases of azoospermia (no sperm seen at analysis) it may be possible to retrieve sperm by surgical methods directly from the testes via procedures known as PESA, TESA or micro-TESE.
#2 - Surgical sperm retrieval
In cases of azoospermia, microsurgical sperm extraction may be an option. A urologist performs a surgical procedure to attempt to extract sperm directly from the testicles for use in assisted conception. Fertilisation then usually takes place in the IVF lab via a treatment called ICSI (intracytoplasmic sperm injection) to carefully inject a single sperm into each egg.
#3 - Assisted conception
The treatments involve obtaining sperm through normal ejaculation, surgical extraction, or from a sperm donor, depending on your specific case and choices. The sperm can then either be inserted into the female genital tract via intrauterine insemination (IUI), or fertilisation can take place outside of the body by performing IVF or ICSI.
#4 - IUI
For men who have sufficient or borderline numbers of healthy, motile sperm. This treatment involves semen sample production and laboratory preparation. The washed sperm is then inseminated through the cervix into the woman’s uterus. If donor sperm is used, then this procedure is called IUI-DI (donor insemination).
“If you are faced with a mountain, you have several options. You can climb it, go round it, dig under it, fly over it or blow it up. You can ignore it and pretend it's not there. You can turn around and go back the way you came" – Vera Nazarian
#5 - IVF
Like IUI, this treatment may work for men who have sufficient or borderline numbers of healthy, motile sperm.. However, this treatment requires the washed sperm to be added to several of your partner's eggs, for fertilisation outside of the body (in vitro). Any resulting embryos are carefully incubated under strict laboratory conditions, and the most promising embryo is transferred into your partner's womb.
#6 - ICSI
For men who have either few or no sperm in their semen, poor quality sperm, or have required surgical sperm retrieval. This is a type of IVF treatment whereby a single selected sperm is directly injected into an egg to overcome issues with the limited sperm movement or number, to encourage fertilisation. The fertilised egg is then transferred to the woman's womb.
#7 - Donor sperm
Certain sperm problems may be so severe that you need to consider using sperm donated by another man (sperm donor). Donor insemination is an alternative to ICSI, with very poor quality sperm or if there is a genetic disorder that could be passed on to any children. Donor sperm can be used for IUI (IUI-DI) or as part of an IVF treatment if required.
Do you have any questions about management of assisted conception?
We hope this blog has helped explain some of the treatment options to manage male fertility. For further information or to book a semen test please contact us on: