Treatments for Male Infertility and related conditions
Medical treatment can be used effectively in the following cases:
- Correction of the hormonal imbalance in certain cases of hormonal infertility.
- Treatment of chronic infection of the genital tract.
Medical treatment can also be used empirically to boost fertility and improve IVF outcomes by giving antioxidants and FSH/LH hormonal stimulation.
Surgery for Zero sperm count (Azoospermia)
Azoospermia occurs in 1% of the general population, and in 10-15% of the infertile male population. It may be functional or non-obstructive (NOA) or Obstructive (OA)
NOA: The management of NOA depends on finding sperm in the testes and retrieving the sperm surgically so it can be used in IVF treatment. This is because men with NOA may have patchy areas inside the testes where there is some sperm production that is not enough to appear in the ejaculate.
At City Fertility we offer the best and most advanced technique of finding sperm in men with NOA, that is Micro-dissection testicular sperm extraction (Micro-TESE) which is superior to any other technique in men with NOA. This technique uses state of the art surgical microscope, under high magnification an experienced microsurgeon will identify the areas that are most likely to contain sperm and selectively take tiny pieces from these areas to give it to the embryologist.
Most units do not offer this technique because it requires an experienced microsurgeon, an expensive microscope, and theatre time as it may take the surgeon up to 2 hours to find sperm.
OA: Some of the causes of obstructive azoospermia can be treated by microsurgical procedures (epididymo-vasostomy in epididymal blockage and vaso-vasostomy in blockage of the vas deferens), these procedure aim at reconnecting the seminal ducts and bypassing the blockage. In cases of ejaculatory duct obstruction (EDO) transurethral resection of the ejaculatory ducts (TURED) is performed to resect the blockage.
If this is not indicated or fails, surgical sperm retrieval is offered and the sperm is extracted for use in IVF.
Several techniques may be used depending on the site of obstruction such as per epididymal sperm aspiration (PESA), Micro-surgical sperm aspiration (MESA), testicular sperm aspiration (TESA), percutaneous testicular sperm extraction (Perc TESE) and window testis biopsy.
Sperm retrieval in OA is easier than NOA because sperm production is normal.
Mr Raheem is an experienced microsurgeon with special interest in male infertility. His skill and advanced techniques offer males with zero sperm count the best chances of fathering their own child.
A varicocele means that the veins draining the testes become dilated and incompetent. It similar to varicose veins which affect the legs but this affects the testes. Varicoceles affect fertility by several mechanisms including elevation of the scrotal temperature and increased sperm DNA fragmentation. Varicocele repair has been shown to improve semen parameters, improve natural fertility as well as IVF outcomes. Furthermore men who have non obstructive azoospermia (NOA) and a varicocele may start showing sperm in the ejaculate after varicocele repair and those who still have zero sperm count will have a higher chance of finding sperm compared to men with varicoceles that are not repaired.
At City Fertility we offer sub-inguinal microsurgical varicocelectomy which is the treatment of choice for varicoceles. It is a minimally invasive surgery which allows identification and division of all the dilated veins while sparing the arteries and lymphatic vessels.
Vasectomy and Vasectomy Reversal
Vasectomy is an extremely reliable method of contraception which is more than 99% effective, the surgery aims at interrupting the vas deferens which is the tube that carries sperm from the testis. Mr Raheem has developed a new technique of performing vasectomy using the surgical microscope “Micro-surgical vasectomy” which aims at carefully dissecting the vasal blood vessels and nerve containing facia off the vas deferens before dividing and ligating it; this aims to reduce the incidence of post-vasectomy pain.
Vasectomies can be reversed surgically by reconnecting both ends. At City Fertility we use a state of the art surgical microscope to give the best possible chances of the best possible result.
Treatment of ejaculation problems
- Anejaculation & Retrograde ejaculation: Some conditions such as diabetes, neurological disease, spinal cord injury, certain medication, abdominal and pelvic surgery makes patients unable to ejaculate or ejaculate into the bladder. Some of these cases may be treated by giving medicine which helps ejaculation. If this doesn’t work a vibrator can be tried; which is an oscillating disc that is applied to the frenulum and may lead to antegrade ejaculation which may be followed by home intravaginal insemination. If this fails patients may have surgical sperm retrieval or electroejaculation.
Electroejaculation is a probe which is inserted tranrectally under a general anaesthetic and stimulates pelvic contractions which lead to antegrade ejaculation.
- Premature ejaculation: Premature ejaculation is a common condition that may affect 40% of males. Sometimes premature ejaculation can be so severe that the patient would ejaculate before penetration “Ante portal premature ejaculation”. Premature ejaculation can be treated medically by giving medicine which delays ejaculation.
Treatment of erectile dysfunction (ED)
Almost half of the men above the age of 50 will have varying degrees of ED; however ED can affect any age group. ED is associated with other health problems such as diabetes, high blood pressure and heart disease. Several lines of therapy are available including pills, injections and surgery. It is observed that many men who are undergoing fertility treatment with their partners develop ED, however this is a transient form due to the performance anxiety of having intercourse at certain periods or the pressure of having to provide a sample at a particular time.
Microsurgical testicular denervation
Many men suffer from chronic testicular pain. This can occur following trauma, surgery, infections or for unknown reasons. In many cases the pain is severe enough to interfere with the quality of life of the affected men. Under the high magnification of the surgical microscope, all the structures which contain nerve tissue that carries the pain sensation from the testes are divided while sparing the vessels and vas deferens. Mr Raheem has been performing this technique with excellent results.
Any man who develops a scrotal swelling requires to be seen urgently by a specialist for an examination and a scrotal ultrasound scan. Although most of the swellings encountered turn out to be benign it is important to rule out testis cancer. Benign swellings include cysts which are fluid filled sacs and hydrocele which the accumulation of large amounts of fluid around the testes; both conditions can be treated by minor scrotal surgery.