Adjusting IVF For Male Infertility
When talking about infertility, people almost always focus the conversation on women. Issues around ovulation, difficulties with implantation, or an inability to carry a pregnancy to term are often considered the female partner’s problem. However, nearly a third of all infertility cases are attributed solely to male issues. For men, difficulties conceiving can be caused by the sperm or trouble achieving or maintaining an erection. If semen-related concerns are the issue, aspiration and extraction approaches can be used in conjunction with in vitro fertilization (IVF) to achieve pregnancy.
What is male factor infertility?
When a man has abnormal semen characteristics, a diagnosis of male factor infertility is made. The condition is the sole cause in 30% of all infertility cases in opposite-sex couples and 30 to 40% of combined reasons. Male factor infertility refers to a man who cannot properly ejaculate semen through natural conception, resulting in an inability to achieve pregnancy after 1 year of trying. Common issues can include low sperm count, poor motility, inferior sperm quality, and even problems with seminal fluid that make mobility difficult.
Whether a man has a low sperm count or releases semen that lacks sperm entirely, solutions can be leveraged during the semen retrieval step of IVF. While most men in IVF couples will rely on ejaculation to create a semen sample, others may need surgical interventions to provide sperm for the fertilization process.
Testicular sperm aspiration (TESA) is an outpatient procedure usually recommended for men that have azoospermia or semen that lacks sperm. In most cases, individuals that undergo TESA have previously undergone a vasectomy and therefore have a physical blockage preventing sperm from being released. The process involves local anesthesia and using a needle to extract sperm and tissue from the testicles.
By contrast, testicular sperm extraction (TESE) is usually performed in an operating room rather than as an in-office procedure. During the process, sedation is used, and an incision is made in the testis. Along with examining the tubules to confirm that sperm is present, most men will opt to have sperm preserved for use during a future IVF procedure. TESE is ideal for individuals with azoospermia.
Picking the right retrieval method
Successful IVF requires a fertilized egg, known as an embryo. To reach this step, enough sperm are needed to boost conception odds. In some cases, low sperm count may require other IVF adaptations, such as intracytoplasmic sperm injection (ICSI), to achieve pregnancy. Regardless of the method, men with known infertility issues related to semen and sperm quality should speak with a fertility specialist to determine the best course of action to retrieve a specimen.