Basically when the infertile couple comes, only the female partner is blamed. Even the family and the society think that it is the problem with the female partner and the male partner is perfectly fine. When they are coming to the infertility clinic, they must come together and they must undergo all the infertility tests or the diagnostic tests. So we can find the male partners problems in the early stage only and can plan the treatment accordingly. If we treat the female partner, we will be treating her for months together or for years together without testing the male partner. So later on when we find the problem is with the male partner, then the entire treatment plan changes. So whatever we have done in the past years, it will go waste. In case the male has sperm factors like reduced motility, reduced sperm count or if the morphology is very poor, what we call as severe oligoasthenozoospermia. In that case, we will see if this condition will be improved with the medicines. If not, we suggest an IUI or IVF. IUI is a simple procedure, where we give certain medicines to grow the eggs in the female partner at the time of ovulation, that is roughly between 13 and 15th day, we will collect the sperm from the husband, we will collect the sample, we process the sample and take only the good quality sperm and inject those sperms into the uterine cavity of the female partner, This will increase the chances of conceiving to 10 – 12 % even if it is a sever malefactor. Even if it is a normal male factor, it will be 15 – 16 % only. So by doing 2 or 3 cycles, we can assess if IUI is going to work for this couple. If IUI is not working, we suggest an IVF, where they have a success rate of 30 – 60 %. In IVF, we collect the eggs from the female partner and inject those eggs with the husband’s sperms. When we are screening the sperms, we select the good quality sperms and inject those sperms into the egg. After that we fertilize and grow it for 3 to 5 days and select the best embryo out of that and inject those embryos, 2 or 3 embryos into the female uterine cavity. After 15 days, we get to know the result of the treatment. Especially useful for male infertility couples. If it is several factors, like the count or the motility is low, in such cases, without waiting for the natural try or an IUI, we directly recommend IVF treatment. Over a period of time, the male factor comes down. So during the initial phase itself, we want to give the best treatment and best success rates if you undergo IVF in the initial period only. Sometimes male partner will present with zero sperm, that is azoospermia, means they will not have any sperms at all, only the semen will be there. In some male partners, only the semen will be there, no sperms will be there in the semen. In such cases, we do certain hormonal tests in the male partner, Doppler scans. After that we try to improve the sperms. A trail of medical treatment is done, we will see if the sperms are appearing in the semen. If they marginality improve, say from zero to 2 or 3 million, the sperms have improved. So use that sperms only. Either we can use an IUI or an IVF and use those sperms only. In majority of the times, the tablets or the injections doesn’t work for this azoopspermic patient. So in those cases, we recommend the male partner to undergo a procedure called as TESA, PESA particularly Micro TESA and Micro PESA. This is done under a local anesthesia, sometime by general anesthesia, where we pass a small needle in the testis or the epididymis, we take out the sperm from the testis or the epididymis. If we obtain a good sperm, we use the same sperm for an ICSI procedure, that is an IVF procedure, means intacytoplasmic sperm injection. These sperms will be stored, and then we will stimulate the female partner to get more eggs. So when we get 7 or 8 eggs, for those eggs, we inject the stored sample of sperms after the TESA, PESA sample. In this way, they can fertilize the egg with their own sperm and utilize those embryos to transfer into the uterine cavity. This is the procedure of test tube baby procedure. So this can avoid the procedure of avoiding donor egg or donor sperm. In this we can achieve 30 to 40% success rate.
Source: What is the role IVF for male infertility? – Dr. Manjunath C S
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