Wednesday, January 30, 2008

Male Infertility and Testicular Sperm Extraction

Male factor infertility is accounted for in approximately 50% of couples attempting to conceive. This is attributed to a wide range of factors including stress, excessive use of recreational drugs, hypogonadism, erectile dysfunction, hypospadias, obstruction of the vas defens, oligospermia, and infections. Azoospermia and necrospermia are among the more serious forms of male infertility and generally require infertility treatment in order to achieve a pregnancy.

Men with azoospermia have no sperm in their ejaculate. This is further categorized into obstructive azoospermia, where there is a blockage in the pathway from the testes to the point of ejaculation, and non-obstructive, where there is a problem producing the sperm in the testes. Necrospermia is where the sperm in the ejaculate is dead or lacks motility. These conditions are congenital and cannot be cured. Immotile cilia syndrome is a congenital disorder in which the sperm are actually alive but cannot move. Live sperm that is arrested in development may not be able to be released from the testes, and in these situations advances in infertility treatment, such as testicular sperm extraction, can provide an infertility solution.

The hormones FSH and LH are responsible for sperm production in men, which begins in the testes. Sperm cells go through several phases in the testes and eventually become mature spermatozoa. Spermatozoa leave the testes and travel into the epididymis. It is here where they develop motility and become fully mature sperm capable of fertilizing an egg. It was once thought that no motile sperm could be found in the testes. This has proven true for cases where there is no obstruction in the pathway. When a blockage is present healthy motile spermatozoa have been found in the efferent ducts or the caput epididymis.

Retrieving the sperm is a relatively simple and painless procedure that can be done on an outpatient basis. The skin is stretched out tightly and a small “butterfly” needle is inserted into the testes. Movement of the needle draws out testicular tubules. The needle is withdrawn slowly taking a strand of testicular tissue with it. The tissue is grasped with forceps and gently pulled from the testes. Placed in a culture medium the sample can be examined under a stereozoom microscope for presence of suitable sperm.

The physician will be looking for healthy motile sperm with proper morphology, or shape. Samples don’t often possess enough sperm for intrauterine insemination (IUI), but can work well with intra-cytoplasmic sperm injection(ICSI). ICSI is a microscopic procedure that requires in vitro fertilization, involving the placement of individual sperm cells into individual eggs using a glass needle. The fertilized egg or preimpantation embryo is then transfered into the uterus. The fertilized egg is then inserted into the uterus. While the process is not without risk, ICSI has become accepted as a relatively safe medical procedure.

About the Author: Eric Daiter has been sponsored by The NJ Center for Reproductive Medicine, a leading provider of infertility treatment, to write information about the infertility solution. For more information, please visit www.infertilitytutorials.com

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