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Bulletin
Between 12 and 15
million couples worldwide experience difficulty in conceiving and the trend is
rising. A male factor contributes to subfertility in 40-60% of these
couples. Over the last few decades, the field of Assisted Reproductive
Technology has come long way in providing assistance to couples with
male factor infertility.
A
routine semen analysis by dedicated lab person speaks volume about male
partner, to determine the number and quality of sperm & to predict the fertilization
potential of a male.
Oligozoospermia
When
sperm are produced by ejaculation but in very low numbers, (<5
million)In-vitro Fertilization (IVF) along with “ICSI” (Intracytoplasmic Sperm Injection) can help
couples achieve a pregnancy. ICSI is performed by directly injecting a single
sperm into one egg using highly sophisticated microscopic instruments. ICSI,
was developed in Belgium
by Gianpiero Palermo, has dramatically changed the treatment available for even
the most severe male factor infertility. Now this facility of ICSI is available
in good 50% IVF centre in Delhi.
Azoospermia, defined as complete absence of sperm
from the ejaculate, is present in about 1% of all men and in approximately 15%
of infertile men.
“Azoospermia” that is Men with zero sperm count can
be divided into two broad groups:
1.
Men who have an obstruction problem or blockage, meaning they
are producing sperm, but the sperm can’t get out ( Obstructive azoospermia)
or
2.
Men who have a production problem, meaning they are not making
sperm, a condition called “non-obstructive ” azoospermia.”
Using
a serum FSH and palpating the male reproductive ducts and size of the testis,
fertility specialists can differentiate between obstructive azoospermia (OA)
and Non-Obstructive Azoospermia (NOA)
clinically. Specifically, an elevated FSH and small testicular size is
consistent with NOA.
In,
OA blockage can also be caused by a urinary tract infection or by the sexually
transmitted diseases like chlamydia and gonorrhea. Infection of the epididymis
can cause scarring and blockage, inhibiting the sperm from leaving the duct to
fertilize an egg.
One
of the most common causes of obstruction is vasectomy. More than a
million men undergo vasectomy each year in this country for permanent birth
control. With an increase in divorce rates, the demand for reversal of
vasectomy is also growing. Approximately 1% of all infertile men are born with
the congenital absence of the vas deferens.
Genetic
testing of men with (NOA) has revealed that 10% to 15% are missing a
small piece of their Y chromosome. This condition is called Y-chromosome micro deletion. The Y chromosome carries the
genes that are responsible for producing sperm. Men who have decreased or
no sperm count might be missing a small piece of that Y chromosome.
Unfortunately treatment of men with Y-chromosome micro deletion to have
children ensures their male children will have the same infertility problem.
Until
the mid 1990′s, donor sperm was the only treatment for azoospermia. A minor
outpatient procedure called “TESA” (Testicular Sperm Aspiration) in IVF centre
offering ICSI may be offered to obtain sperm directly from the testes where it
is produced. If successful, the sperm can then be used with IVF/ICSI.
The most exciting new development in the field of
male infertility is the ability to treat men with severe sperm production
problems called non-obstructive azoospermia. Even though these men may have no
sperm in their semen, we can now find sperm between the cells of the testicles
in almost half of these cases. By using an operating microscope and doing micro
dissection TESE, many researchers have been able to achieve pregnancies in half
of those men in whom sperm can be found within the testicle.
Surgical retrieval of spermatozoa from testes
combined with ART has given new hope to those patients previously considered
infertile. In cases of surgically irreparable obstruction or in cases of
CBAVD, Microsurgical Epididymal Sperm Aspiration (MESA) with standard IVF has
been shown to yield fertilization and pregnancy. However, the results were poor
and unpredictable. TESA is now a well-accepted technique in the treatment of
men diagnosed with OA or NOA but requires ICSI due to the immature
fertilization potential of testicular sperm. Since testicular biopsy is an
invasive procedure, the efficient use of TESA would reduce surgical aspirations
to a single sperm retrieval & than using cryopreservation.
Cryopreservation of TESA specimens can avoid
repeated testicular biopsies in azoospermic patients in whom the only source of
spermatozoa is the biopsy. Testicular sperm cryopreservation using a simple
freezing protocol is promising in patients with AO and NOA augmenting the
overall success achieved after surgical sperm retrieval.
In
summary, TESA with ICSI has successfully treated azoospermia and offers
approximately a 40% live birth rate from OA and NOA patients. Because of this
technique, 90% of all infertile men, including half of all men with
non-obstructive azoospermia, have the potential to conceive their own genetic
child. The freezing and in vitro maturation of testicular biopsy specimens are
useful approaches to the management of testicular biopsy samples from both OA
and NOA patients. These techniques offer the possibility of several attempts at
IVF/ICSI from a single testicular biopsy sample. Lifecare IVF has dedicated
unit to treat such cases with very satisfactory results.
Dr Abhishek Singh Parihar
MBBS ,MS , Fellow. Reproductive Medicine
Consultant – Reproductive Medicine
Lifecare Institute of Infertility & IVF.
MBBS ,MS , Fellow. Reproductive Medicine
Consultant – Reproductive Medicine
Lifecare Institute of Infertility & IVF.
Dr. Sharda Jain
M.D. (PGIMER), MNAMS, FiCOG
FIMSA,DHM,QM & AHO
Consultant : Reproductive Medicine
Programme : Director : Lifecare IVF
WISHES FOR OUR ALUMINI STUDENT SUCCESS IN FUTURE.M.D. (PGIMER), MNAMS, FiCOG
FIMSA,DHM,QM & AHO
Consultant : Reproductive Medicine
Programme : Director : Lifecare IVF
