To answer this question we have to take into account several aspects.
The first of these is the assessment of the male factor. When we speak of oligoazoospermia we refer to a low concentration of sperm in the semen. We consider an altered concentration when there are less than 15 million spermatozoa per milliliter (mL) of ejaculate.
But although 15 million per mL is the reference parameter for talking about oligoazoospermia, when we assess the seminogram we must take into account the degree of deviation from that normality. That is, a concentration of 13 million/mL, where we would speak of a mild oligoazoospermia, is not the same as 1 million/mL, where we would speak of a severe oligoazoospermia. In addition we must also assess the other parameters of the study of the semen (total volume, motility).
In order to group all the important parameters of the seminogram into a single value that will help us decide which assisted reproduction technique to use, the concept of MSC (Mobile Sperm Count) is established. This tells us the number of spermatozoa with good motility in each milliliter of ejaculate after the training of the semen in the laboratory.
It is considered that in order to perform an artificial insemination (AI), the MSC must be over 3 million spermatozoa.
Therefore, as far as the male factor is concerned, it will depend on the severity of the oligoazoospermia and how it influences the MSC whether the technique of choice is an AI or, on the contrary, we have to opt for a more complex technique, such as In Vitro Fertilization (IVF).
The second aspect to take into account is the female factor. In this case we are presented with a woman with a Polycystic Ovary Syndrome (PCOS). PCOS is an endocrine pathology that is often difficult to achieve ovulation. When a woman is unable to ovulate, she will not be able to become pregnant and the clinic that most women with PCOS consult for will appear, which is the absence of menstruation.
Thus, what we must do with this patient is to give her medication to help her achieve, first, follicular development and, later, ovulation. Once ovulation is achieved, the semen sample should be added either by AI or by directed intercourse. One option or the other will depend on the quality of the semen.
To achieve ovulation in a patient with PCOS we perform an "ovulation induction" treatment. For this we have several therapeutic options. As first-line drugs we would have the drugs for oral administration (Clomiphene Citrate and Letrozole) and, as second-line treatment, we would have the drugs for subcutaneous administration (Gonadotropins).
Even so, before considering ovulation induction treatment in a patient with PCOS, we should assess the patient's age. The main reason for this is that ovulation induction treatments end with AI or directed intercourse. It is known that women over 38 years of age do not benefit from these techniques due to poor egg quality. In such cases, the first option should be an IVF.
Therefore, and in response to the initial question, the most likely treatment of choice for this couple is AI with ovulation induction, but before indicating such a technique we must take into account other parameters such as EMR and the age of the patient.
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