Three most widely used methods of infertility treatment for men are:drugs, surgery and Assisted Reproductive Technology (ART). The main factor that determines chosen treatment method is the underlying cause of infertility (click for more information).
Infertility treatment can be a lengthy and challenging process. Patience, commitment and mutual support of couple under treatment have a great influence on the success of treatment. It is important to discuss with the fertility specialist about benefits and possible side effects of the treatment prescribed. Most common infertility treatments for men are explained in this article.
Treatment Using Drugs
Drugs are used to treat hormonal imbalances that harmfully affect sperm production and sperm quality, infections in reproductive tract and other problems such as retrograde ejaculation.
Clomiphene citrate (Clomid), human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) are the commonly used fertility drugs for men (Clomid and hMG are used to treat infertility in women too). All these drugs induce testes to produce more testosterone (male sex hormone) in order to increase sperm count and sperm quality. Clomid is administered in tablets, while hMG and hCG are administered by injections.
Infertility can also be caused by infections in reproductive tract or sexually transmitted diseases such as Chlamydia. Antibiotics can be used to treat these conditions.
Treatment for Retrograde Ejaculation
Retrograde ejaculation is a condition in which muscles of the bladder dysfunction and sperm is forced to flow backward into the urinary bladder instead of moving forward to the penis. This can result in low ejaculate volume, low sperm count, low sperm quality and cloudy urine after ejaculation.
Retrograde ejaculation can be treated using drugs such as pseudoephedrine or imipramine. These medications can help to keep bladder neck closed during ejaculation, preventing retrograde ejaculation. Some times retrograde ejaculation may be a side effect of a medication. In this case, stopping that medication or switching to another drug can prevent retrograde ejaculation.
If treatment using drugs is ineffective or if there is a severe damage to nerves or muscles of the bladder, it may not be possible to restore normal ejaculation. In such a scenario, a fertility specialist can help to retrieve sperm either from urine or from the reproductive tract through a minor surgical procedure. These retrieved sperm can be used for infertility treatment through assisted reproductive technologies such as: intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Following surgical methods can be used for infertility treatment for men.
Varicocele Ligation or Varicocelectomy
Varicocele is enlargement of varicose veins around testes. This raises temperature in testes, causing reduced sperm count and abnormal sperm morphology. Varicocele ligation or varicocelectomy is a micro surgical procedure to treat varicocele by tying off distended veins.
Resection of Blockages in Vas Deferens or Ejaculatory Duct
Sperm is transported from testes to penis through vas deferens (a pair of tubes, one from each testicle) and ejaculatory duct. Blocks in vas deferens or ejaculatory duct can result in low sperm count or complete absence of sperm cells in semen. This condition can be corrected with the help of a relatively simple micro surgical procedure.
If the surgical treatment to remove blockage is not successful, next best option is to retrieve sperm from reproductive tract through a minor surgery and use these sperm for treatment through assisted reproductive technologies such as: intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Vasectomy is a surgical procedure used to make a man sterile. In vasectomy, vas deferens (tubes through which sperm travels from testes to urethra) are severed and sealed, disrupting sperm flow.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology (ART) is an advanced method used to treat infertility in both men and women. It is important to discuss with the fertility specialist about pros and cons of ART treatment. Most common ART treatments for men are explained below:
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) can be performed in conjunction with in vitro fertilization (IVF). ICSI may be recommended for men who suffer from sperm disorders such as low sperm count, complete absence of sperm cells in semen, poor sperm motility or abnormal sperm morphology. These disorders prevent sperm from successfully penetrating and fertilizing an egg. ICSI can also be used to treat infertility in men caused by premature ejaculation, erectile dysfunction or if previous attempts of IVF failed to achieve a successful pregnancy.
Treatment starts with collection of sperm either from normal ejaculate of male partner or from the reproductive tract of male partner and retrieval of ovaries (eggs) from female partner. Donated sperm and/or ovaries can also be used for ICSI. In a laboratory setting, a selected single sperm is injected into the cytoplasm of an egg. This makes it easier for the sperm to penetrate the egg and fertilize it. Then another single sperm and egg are picked from the sample and same process is repeated (it is repeated a few times to increase chances of formation of multiple embryos). One or more healthy embryos formed are then transplanted into woman’s womb (uterus). There is a possibility of having multiple pregnancy (pregnancy with two or more foetuses), if more than one embryo is transferred to a woman’s womb. This has a few risks associated with it. It is advisable to discuss with the fertility specialist about it.
In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI)
In vitro fertilization (IVF) and intrauterine insemination (IUI) can be used to treat men suffering from sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction. Sperm collected from ejaculate, sperm retrieved from reproductive tract through surgical procedures or donated sperm can be used for IVF and IUI. Click IVF procedure and IUI procedure for detailed explanation on how IVF and IUI work.
Possible Adverse Effects of Infertility Treatment for Men
One of the main risks associated with infertility treatment using assisted reproductive technology (ART) is multiple pregnancy (pregnancy with two or more foetuses). In treatment methods such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), one or more embryos may be transplanted into a woman’s uterus. This can result in multiple pregnancy. Multiple pregnancy can cause high blood pressure and diabetes in mother, premature labor and babies having low birth weight.
During an ART treatment, if sperm is not present in ejaculate of a man due to conditions such as retrograde ejaculation or blocks in vas deferens or ejaculatory duct, it might be needed to retrieve sperm from reproductive tract through a minor surgery (other option is to use donor sperm). This surgical procedure to retrieve sperm has a very low risk of infection and damage to testes.
Infertility treatment for men, using fertility drugs can cause side effects such as temporary blurred vision, breast enlargement, acne, weight gain, allergic reactions and damage to liver in rare cases.
Infertility treatments can also cause birth defects in babies, but chances for this to happen are very low.