Infertility

Treatment of Male Infertility

About 40 percent of infertility is caused by problems with the man's sperm, either due to:

• Low sperm count (not producing enough sperm) — Low sperm count can result from blockage of the passages that carry the sperm.
• Poor sperm quality (sperm that do not move well or are misshapen) — Sperm abnormalities may be caused by different diseases, malnutrition, genetic disorders, environmental factors or a combination of these.

Treatment Options

There are two main approaches to the treatment of male infertility, vasectomy reversal (vasovasectomy) and assisted reproductive technology.

Vasectomy Reversal (Vasovasotomy)

Occasionally, men who have had a vasectomy (an operation in which the tubes carrying the sperm are cut to prevent pregnancy) find that their lives have changed and they now want to have a family. Provided they are in good general health, they can choose to undergo a vasovasotomy, an operation that reverses vasectomy and restores a man's ability to conceive through regular intercourse. Assisted reproductive technology may also be an option (see below).

In vasovasotomy, the sperm-carrying tubes that were cut in vasectomy are reconnected. The operation is performed under regional or general anesthesia and lasts several hours. Urologists at the Mayo Clinic have extensive experience performing these operations and report a success rate of over 90 percent in restoring fertility in men who have had vasectomies. Vasovasotomies are most successful in men who have had vasectomies within 5 to 10 years of having the reversal operation.

For men for whom vasectomy reversal is not recommended or who prefer another option, assisted reproductive technology may be an option.

Assisted Reproductive Technology

The sperm a man produces is extracted from his testes, ejaculate or from the tubes that carry sperm to the testes using a procedure called sperm aspiration. The sperm is then treated in different ways and used to fertilize an egg. Fertilization can take place either directly in the woman's body, through artificial insemination or in a laboratory through in vitro fertilization.

In most cases, Mayo specialists in reproductive endocrinology fertilize eggs outside of a woman's body and then implant them into the woman's uterus. Eggs are either extracted from the woman's body or obtained from a donor.

Intracytoplasmic sperm injection (ICSI) is used when other ART procedures fail or when the man's infertility problems are very serious. In ICSI, a single sperm is injected into a single egg using microscopic instruments. Mayo doctors report a success rate of close to 50 percent with ICSI procedures and a similar rate in all cases when an embryo has been created and transferred into a woman's uterus using ART. Success means not only establishing pregnancy, but the pregnancy ending in a live birth.