Male Infertility

Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg. One third of all infertility cases have been linked solely to issues with the male partner.

Sperm Production Problems

Problems with sperm may exist from birth (undescended testes, genetic abnormality) or develop later in life due to illness (mumps, cancer treatment) or injury (repeated scrotal trauma).

Sperm production problems: The quality and quantity of sperm are the key factors to male fertility. Any defect such as immature sperm or low sperm count (oligospermia) or no sperm (azoospermia) can lead to infertility.

Causes of Azoospermia

  • Genetic Abnormality - Kleinfelter’s Syndrome, Cystic Fibrosis, Chromosomal translocations and deletions

  • Following a vasectomy or other obstruction (including due to infection)

  • Testicular failure

Causes of low Sperm Counts

  • Varicoceles: This is a condition characterized by swelling of the veins that supply the testicle.

  • Backward ejaculation of the sperm

  • Blockage of the sperm-carrying ducts

  • Development of sperm antibodies (autoimmune disorder)

  • Hormonal/stress problems

  • Infections/tumours of the male reproductive system

  • Genetics (chromosomal disorders)

  • Sexual problems

  • Use of certain medications such as steroids

  • Excessive radiation exposure affects the sperm production.

  • Work-related causes (eg: exposure to toxins in paint)

  • Smoking and alcohol abuse

  • Environmental toxins, including pesticides and lead.

Treatments for Male Infertility

With the advancements in medical technology, it is now possible to treat this condition. Treatment options include:

  • Surgery: Surgery is indicated in cases of varicocele and obstruction of the sperm duct to improve the sperm motion.

  • Medications: Antibiotics are prescribed to treat infections of the reproductive system.

  • Treatment for sexual problems: Counselling about sex and relationships can help boost fertility levels.

  • Male hormone replacement therapy may be used to treat hormonal deficiency.

  • Assisted reproductive technology (ART): These are revolutionary treatment procedures that can help couples with infertility problems to conceive. Some of them include In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) methods.

  • Lifestyle modification: This would include changing habits such as not smoking, limiting alcohol intake, and using stress reduction techniques.

  • In cases of azoospermia and in some cases of significant genetic disorders, donor sperm is required

  • Cancer Related Issues for Fertility: Radiotherapy and chemotherapy may damage the quantity and quality of sperm in men. Cancers of the reproductive organs such as the testicles and ovaries may require surgical removal, thus affecting the ability to reproduce. 

Preservation Prior to Cancer Therapy

Fertility-preserving procedures are most commonly performed before cancer treatment.

Fertility-preserving options in men

  • Freezing sperm prior to treatment

  • Physically protecting the testes from radiation therapy.

  • In boys who have not entered puberty, a small portion of the testicular tissue, containing stem cells that will eventually become sperm, is extracted, frozen and stored.

  • Percutaneous Epididymal Sperm Aspiration (PESA)- this procedure is performed in a Day Stay Unit under General Anaesthesia. It takes about 30 minutes. Dr Cook will perform this procedure. The sperm are aspirated from the epididymis using a needle. It is most commonly used in men who have had a vasectomy. Most men can return to normal activities the next day. There will be minor discomfort and bruising.

  • Testicular sperm Aspiration - this procedure involves aspirating testicular tubules from the testes. Dr Cook will perform this if there are inadequate sperm collected from PESA. This procedure is also performed in a Day Stay Unit. The immature sperm are removed from the tubules by the scientist. When there is evidence of movement in the sperm, they are considered viable and can be used to fertilise the egg using ICSI. Most men can return to normal activities the next day. There will be minor discomfort and bruising.

  • Testicular biopsy - Dr Cook will perform this procedure if there are inadequate sperm from PESA or TESA. A small cut is made in the testes and tubules are removed. The scientist will remove the immature sperm from the tubules for use in fertilising the egg using ICSI. The small incision in the testes is closed with a suture. Most men can return to normal activities the next day. There will be minor discomfort and bruising.  

Robotic treatment for male infertility

Male infertility is a significant cause of infertility in almost half of infertile couples. Over the last several decades, treatment of infertility has advanced with the emergence of new assisted reproduction techniques like In-Vitro Fertilization (IVF), Intra-Cytoplasmic Sperm Injection (ICSCI), and microsurgery techniques including robotic surgery. Advanced robotic surgery has a remarkable success rate and is of exceptional advantage in treating male infertility.

Surgical procedures performed using robotic technology allow for unmatched precision, dexterity and control for the surgeon compared to other conventional techniques. Robotic surgery is less invasive, safe and offers several advantages over traditional open surgery. Furthermore, patients experience much less pain, minimal scarring, decreased blood loss, less complications and shorter hospital stay with an early recovery and return to work.

The robotic treatment options available to treat male infertility include:  

Robotic Vasectomy Reversal

Robotic vasectomy reversal or robotic vasovasostomy is an operative procedure to restore fertility to previously vasectomized men. The procedure involves reconnecting the cut ends of the vas deferens (a tube for passage of sperm from the testicle to the urethra) during vasectomy. Most of the vasectomized men are likely to have an obstruction in the epididymis (the storage vessel for sperm, located behind the testicle). In such patients, Robotic Vasoepididymostomy is the available option. Robotic vasoepididymostomy involves cutting the distal end of vas deferens and connecting it directly to the epididymal tubule above the level of blockage or obstruction in the epididymis. Robotic surgery reduces overall surgery time, improves the healing rate and allows more flexible and precise suturing of the incision. Bleeding within the scrotum, infection, blockage of the vas deferens (possibly by blood clots), and damage to nerves and blood vessels impeding fertility are the possible complications after a robotic vasectomy reversal.

Robotic TESE (Testicular Sperm Extraction)

In azoospermic men, who have no sperm in their ejaculate, robotic testicular sperm extraction (TESE) is a possible option to retrieve sperm flow. The robotic TESE improves the performance of mapping testicular blood flow, determines the areas of concealed sperm in the testes for extraction, and helps to cure infertility.

Robotic assisted microsurgical varicocelectomy is a suitable surgical option for infertile men with varicocele, dilation of the pampiniform venous plexus in the scrotum. These dilated veins can cause sperm abnormalities and lead to infertility.  Varicocelectomy procedure involves ligation of the dilated and abnormal veins that drain the testicle.