Infertility treatments male
Approximately one in five couples have trouble conceiving a child. If a couple is unable to conceive after one year of unprotected intercourse, they are said to be subfertile. Around 40 per cent of fertility problems originate in the man, with causes including sperm abnormalities and blockages within structures of the reproductive system, such as the vas deferens. Many men have sufficient sperm to fertilise their partner's eggs in a test tube, even if they are unable to do so during sexual intercourse. In most cases, the couple can be helped with assisted reproductive technologies. For around one in 10 couples investigated for infertility, no cause is found. This is known as 'idiopathic infertility'.
Diagnosis methods
Investigating suspected infertility requires a range of tests for both the man and his partner. Some of the tests the man may undergo include:
· Physical examination - including medical history.
· Ultrasound scans - to check the health of reproductive organs.
· Blood tests - to check sex hormone levels.
· Semen analysis - a sperm sample is checked for abnormalities and antibodies.
· Testicular biopsy - the fine network of tubes within the testicles is checked for the presence of sperm.
A range of reproductive technologies
Some of the reproductive technologies available to infertile men include:
· Surgery
· Hormone therapy
· Artificial insemination
· In vitro fertilisation (IVF)
· Intra cytoplasmic sperm injection (ICSI).
Surgery
Fertility may be impaired by varicocele, or the bloating of veins inside the testes. This condition can be surgically treated. The tubes within the male reproductive system that transport sperm may be blocked, perhaps by injury or vasectomy. In some cases, the blockage can be surgically removed or the tubes repaired. If this doesn't work, the man may undergo another surgical procedure called percutaneous epididymal sperm aspiration (PESA). Under local anaesthetic, a slender needle is inserted into the epididymis, which is the tube at the back of the testicle that collects and stores sperm. Sperm is removed, and either used immediately for IVF or frozen.
Hormone therapy
The pituitary gland in the brain releases the hormone gonadotropin, which prompts the testicles to produce sperm. In a small number of cases, male infertility is caused by insufficient levels of gonadotropin. Taking a synthesised version of this hormone can boost sperm production.
Artificial insemination
The man's semen is collected, washed and concentrated, then introduced (via instruments) into his partner's vagina, cervix, uterus or fallopian tubes, depending on the circumstances. This option is often chosen if the husband has functional problems (such as impotence), or if his sperm can't make it through the cervix to the uterus. Some of the factors that can stall sperm at the entrance to the uterus include:
· The man's seminal fluid contains antibodies that destroy his sperm
· The cervical mucus contains antibodies that destroy his sperm
· The cervical mucus is so acidic that sperm are unable to survive.
In vitro fertilisation (IVF)
In vitro fertilisation (IVF) is conception within a test tube (or similar). The woman undergoes ovulation induction (hormonal stimulation of her ovaries) and a number of eggs are removed. This is done through the vagina under ultrasound control. The collected eggs are then mixed with sperm previously collected from the woman's partner, and placed in a special incubator. The fertilised eggs are then implanted into the woman's uterus via a thin tube inserted through the cervix.
Intra cytoplasmic sperm injection (ICSI)
Sometimes, semen contains too few sperm to make fertilisation possible through IVF. In this case, intra cytoplasmic sperm injection (ICSI) can be used. The eggs are removed from the woman's ovaries, then individually injected with a single sperm each. When the eggs are fertilised, the embryos are transferred into the uterus.
Pregnancy isn't always possible
Despite the sophistication of assisted reproductive technologies, pregnancy doesn't always happen. It depends on a range of factors, including the type of technology used and the reasons for the man's infertility. It should be remembered that assisted reproductive technologies can't improve the quality of sperm. Azoospermia, for example, means that the man's semen doesn't contain any sperm at all. In such cases, donor insemination may be considered. This involves artificially inseminating the partner with sperm from an anonymous donor.
Where to get help
· Your doctor
· Family Planning Victoria Tel. (03) 9257 0100
· Monash IVF Tel. (03) 9429 9188 or 1800 628 533
Things to remember
· Around 40 per cent of fertility problems originate in the man, with causes including sperm abnormalities and blockages within structures of the reproductive system, such as the vas deferens.
· Some of the reproductive technologies available to infertile men include surgery to clear blockages, hormone therapy, artificial insemination, in vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI).
Conceiving a baby - how to improve your chances
The odds of a young fertile couple conceiving by having sexual intercourse around the time of ovulation (the release of the egg from the ovary) are approximately one in five every month. Around nine out of 10 couples achieve a pregnancy after one year of unprotected sex. There are various strategies that can improve your odds of conceiving. Identifying the woman's fertile phase is the most important.
Pre-pregnancy tests
It is a good idea to see your doctor and make sure you are physically fit and healthy for an impending pregnancy. Some of the tests you may consider include:
· General examination.
· Pap smear.
· Tests for any sexually transmitted diseases (STDs), such as chlamydia, which can interfere with fertility.
· Blood tests to check for anaemia, your Rhesus factor and your immunity against rubella (German measles).
· Urine tests to check for diabetes.
· If you have a cat, or eat very rare red meat, a test for toxoplasmosis infection.
Timing sexual intercourse
The most important factor when trying to conceive is to have sexual intercourse during the woman's fertile phase - that is, the five days leading up to ovulation and the day of ovulation itself. New life begins when an egg (ovum) from a woman is fertilised by sperm from a man. Ovulation occurs around 14 days before the start of the menstrual period, when an egg is released from one of the ovaries. Conception occurs when the egg is met by a sperm in the fallopian tube. Having sex in the days prior to ovulation (when the woman is aware of a slippery sensation at the vulva) and on the day of ovulation (usually the last day of the slippery sensation) increases the odds of pregnancy. Couples who have sexual intercourse around the middle or later stages of the woman's menstrual cycle may have already missed the egg, which has a short lifespan.
The 'fertile window'
Recent research published in the British Medical Journal (18 November 2000) indicates calendar calculations of the fertile 'window' may be unreliable. A couple needs to learn to recognise the fertile phase of the woman's cycle by being aware of the sensation at the vulva. Having intercourse on the days of the slippery sensation at the vulva increases the odds of pregnancy.
Ovulation mucus
A woman produces a particular type of mucus during her fertile phase, which can help the couple to time their sexual intercourse. The mucus, which produces a slippery sensation, is vital for sperm to survive. Other signs of fertility include a softening and swelling of the woman's external genitals (vulva). Instruction by trained teachers of the Billings method of natural family planning can help a couple to learn to identify the woman's fertile phases.
Factors which interfere with ovulation
A woman who is underweight may ovulate erratically, or not at all. Generally, a woman who weighs less than 50kg should see her doctor for advice. Ovulation can be disrupted by other lifestyle factors, including:
· Excessive exercise - too much exertion releases hormones that interfere with the female sex hormones oestrogen and progesterone.
· Emotional stress - stress affects the hypothalamus, which is the brain structure that oversees the menstrual cycle.
· Disordered eating - such as crash dieting and skipping meals.
Diet
There is no special diet that improves the odds of conception, but now is the time to start eating a healthier range of foods including fresh fruits, vegetables and lean meats. There is no evidence to support the theory that taking supplements of vitamin C boosts fertility. It is recommended that women increase their intake of folate for a few months prior to conceiving and throughout the first few weeks of pregnancy, since this B-group vitamin has been found to reduce the risk of certain birth defects. Good sources of folate include leafy green vegetables. Folate supplements are also recommended.
Cigarettes and alcohol
Cigarettes, marijuana use and alcohol are not only harmful to a developing baby, but can interfere with fertility. Quitting cigarettes will improve your overall health and your odds of conception. A woman who is trying to conceive should strictly limit her consumption of alcohol and avoid binge drinking completely.
Fertility problems
A couple isn't suspected of fertility problems until they have tried and failed to conceive for one year. Around 40 per cent of fertility problems are female and 40 per cent are male. The remaining difficulties are caused by unknown factors.
Where to get help
· Your doctor
· Billings Family Life Centre Tel. (03) 9481 1722 or 1800 335 860
· Family planning clinic
· Family Planning Victoria Tel. (03) 9257 0100
Things to remember
· Knowing when you ovulate increases your chance of pregnancy.
· Having sex in the days prior to ovulation, when the slippery mucus is present, and on the day of ovulation itself increases the odds of pregnancy.
· Keeping a chart of the woman's cycle according to the Billings ovulation method may help to alert her doctor to any potential problems which may be affecting her fertility.
In vitro fertilisation
In vitro fertilisation (IVF) is the process used to conceive a child outside the body. A woman's eggs and a man's sperm are placed together in a plastic dish for fertilisation. Once fertilised, the resulting embryos are placed back in the woman's uterus in the hope that a successful pregnancy will follow.
The IVF procedure
IVF is not one simple procedure, but a series of steps over several weeks. The steps involved in this procedure are outlined below.
Stimulating the ovaries
Hormones are usually given to stimulate the ovaries to produce more than the usual one egg per cycle. This is to enable the collection of several eggs.The development of the eggs is monitored by one or two blood tests and ultrasounds. The ultrasound and blood tests ensure that eggs are collected at precisely the right time.
Collecting the eggs
The ultrasound is inserted in the vagina and a very fine needle is threaded through a guide, which is attached to a probe. Only a light anaesthetic is required for this procedure. The ultrasound monitor shows where the follicles are. The needle pierces the follicle and extracts the follicular fluid, which contains the egg.
Fertilisation and embryo transfer
A couple of hours after egg collection, the man provides a sample of semen. In a standard IVF treatment, the eggs are mixed with the sperm in a culture dish. For intracytoplasmic sperm injection (ICSI) treatment, one sperm is injected directly into the cytoplasm of each egg.
If an egg is fertilised by a sperm, a zygote or pre-embryo will begin to develop. The pre-embryo remains in the incubator for one or two days, until it has divided into two or four cells. Following fertilisation, two to three embryos will be transferred to the uterus using a soft, fine catheter. This procedure (known as embryo transfer) is quite painless, similar to a smear test, and requires no anaesthetic.
For the gamete intrafallopian transfer (GIFT) program, eggs and sperm are placed directly into the fallopian tubes, allowing fertilisation to take place in the natural way. The procedure is performed using a laparoscope, and a general anaesthetic is required. This procedure is rarely used now.
Pregnancy test results
Two weeks after the transfer, a blood test is taken to determine if the woman is pregnant.
Possible risks and side effects
There is no clear evidence that infertility medicines, if properly used, increase the risk of birth defects or cancer. The increase in the hormone oestrogen can cause breast tenderness, slight nausea, dizziness and slight abdominal swelling. Occasionally, too many follicles develop and a condition called ovarian hyperstimulation syndrome (OHSS) may occur. This is an unpleasant experience, which may include marked abdominal swelling, nausea, vomiting and diarrhoea, lower abdominal pain and shortness of breath. There is also a theoretical risk (very rare) of damaging organs, or causing infection or bleeding, with the collection needle.
Where to get help
· Your doctor
· Your local community health centre
· Family Planning Clinic
· Monash IVF Tel. 1800 628 533
Things to remember
· IVF is a process where fertilisation of an egg occurs outside of the body.
· IVF is not one procedure but rather a series of steps taken over several weeks.
· While infertility drugs have some side effects, there is no evidence that they cause cancer or birth defects.
