There are many problems that may cause male infertility, but mainly four different factors may be affected: pre-testicular or endocrine factor, testicular factor, post-testicular factor and spermatic factor, which is the one that refers to the quality of the spermatozoa.
The different sections of this article have been assembled into the following table of contents.
Indications of the treatment
A sperm analysis is needed to check the degree of infertility in men. Depending on the result of this test, the degree of infertility of the man will be determined, as well as the most recommended treatment. How long the infertility has last and the state of the couple must be taken into account. But focusing on the man there are:
Artificial insemination (AI)
It’s indicated for cases in which a mild pathology is suffered:
- Total motile sperm count between 30-50 million.
- Mild oligozoospermia with a motile sperm count after capacitation > 3 million.
- Morphology of the spermatozoa with Kruger criteria > 4% with normal morphology.
In vitro fertilisation (IVF)
It’s indicated for cases of severe pathology, be it for problems with the quantity of spermatozoa, or sperm morphology or motility.
- Severe oligozoospermia, less than 3 million spermatozoa per ml.
- Mild teratozoospermia with less than 4% of normal spermatozoa.
It’s recommended as a treatment for the most severe cases of male infertility:
- Oligoteratozoospermia: with three million motile spermatozoa per millilitre and normal morphology between 1-4%.
- Extremely severe oligozoospermia, with less than 3 million spermatozoa per millilitre.
- Testicular biopsy.
- Epididymal aspiration of spermatozoa.
- Astenozoospermia: severe alterations in the motility of the spermatozoa.
It’s a procedure similar to ICSI but with a microscope magnification, which means that choosing the spermatozoa is easier. It’s indicated for cases of severe teratozoospermia and failures in previous ICSI.
It’s also named annexin V colums. It’s indicated for severe problems of male fertility, since it allows a better filtration of the spermatozoa, and with these spermatozoa without problems an ICSI would be carried out. It’s indicated for men with a high degree of spermatic fragmentation or previous repeated failures with ICSI.
It’s also known as physiological ICSI. The same procedure as in a conventional ICSI is carried out. The difference lies in the fact that, before performing the micro-injection, a special selection of the spermatozoa is carried out. The spermatozoa are set in a special dish that contains areas with a high content of hyaluronan. The spermatozoa that adhere to these areas are the ones used for the microinjection. With this technique is assured that these spermatozoa are able to recognize the molecule that covers the oocyte and fuse with it.
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