The treatment of male factor infertility in our San Antonio fertility center
Once a specific male factor infertility diagnosis has been made, our doctors will institute treatment to optimize the number of healthy, motile sperm, Sometimes, the results are so significant that our physicians may recommend that the couple continue attempting conception on their own. If this is not likely to be successful, Drs. James and Munch will recommend one of several well accepted alternative treatments, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
In order for fertilization to happen naturally during intercourse, the sperm have to swim through the cervical fluid, enter the uterus, and then propel themselves into the fallopian tube. Once inside the fallopian tube, they locate the egg and, through a very complex process, one sperm penetrates the egg and releases its DNA. This process is called fertilization. Ideally, there should be millions of sperm in the ejaculate in order for thousands to make it into the uterus, a few hundred to enter the fallopian tube, and one to fertilize the egg.
Intrauterine insemination or IUI
When a man has a relatively low sperm count or mildly depressed motility, our doctors may recommend intrauterine insemination (IUI). This treatment involves isolating the moving sperm from the ejaculate in our laboratory, concentrating them into a small volume (ideally yielding at least 10 million moving sperm), and then inserting the sperm painlessly into the woman’s uterus. By placing hundreds of thousands or even millions of moving sperm inside the uterus, the likelihood of successful fertilization is increased.
IUI is performed either after a positive ovulation predictor kit (LH surge), or after follicles are seen on an ultrasound and hCG is given to cause ovulation.
In vitro fertilization or IVF
Oftentimes, men with more severe forms of male factor infertility will not be able to produce a semen sample that yields at least 10 million moving sperm. In these cases, IUI is less successful and as a result, our physicians may recommend treatment with in vitro fertilization (IVF). IVF involves stimulating the woman’s ovaries with powerful fertility drugs so that she makes several mature eggs. These eggs are then removed and taken into the IVF laboratory where they are combined with tens of thousands of sperm in a small droplet of a special fluid called culture media. By eliminating the long distance that sperm have to travel, IVF enables successful fertilization with low numbers of sperm as well as with sperm that have low motility. We normally achieve 75% fertilization rates with IVF.
Following fertilization, the early embryos are cultured in the laboratory for 5-7 days as they continue their development. When they reach the blastocyst stage (typically 128 or more cells), they are frozen for transfer into the woman’s uterus during a later cycle.
Intracytoplasmic sperm injection or ICSI
In cases where men produce very low numbers of sperm, or sperm with low (or even no) motility, even IVF may not lead to successful fertilization. In these severe situations, our embryologists can actually pick up a single sperm with a microscopic needle and inject it directly into a mature egg that was obtained as part of the IVF procedure. This procedure is called intracytoplasmic sperm injection, or ICSI. Discovered in the late 1980s, ICSI is now commonly performed by leading IVF programs around the world.
Following fertilization, embryos obtained through ICSI are cultured and frozen just like embryos obtained through IVF. Our embryologists are so proficient at ICSI that they can give men with the most severe sperm abnormalities the same 75% fertilization rates as those who don’t require ICSI.
Contact us to arrange for a new patient consultation with Dr. James or Dr. Munch. If you have been trying to get pregnant, and suspect the cause may be male infertility, Our doctors have the experience and the skill to help most men successfully overcome a diagnosis of male infertility, so they can go on to have healthy children.