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Male factor is one of the big three that make up 50% of the causative factors of infertility. So at IVF Namba we focus on the treatment of male infertility. Although classically the judgment of a semen exam is done according to well established WHO criteria, we believe that this differs entirely from reality and could lead to inappropriate treatment. So, we have established our own basis for judgment of normal semen based on data from over ten thousand cycles. We do not judge only by numbers of sperm or motion patameters, but choose our method of treatment by careful judgment of multiple parameters, including functional tests that show the likelyhood of fertilization including the ability of the sperm to fuse with the zona pellucid.. We involve specialists from the urology department at (which?) university who specialize in treating male infertility for any operation and/or medical treatment for any kind of male infertility.
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Male infertility is characterized by the ability to “produce enough sperm for fertility, ejaculate through the vas deferens by normal sexual intercourse without any difficulty, but having difficulty to fertilize inside the female body”. In order to gain an understanding of the underlying problem we mayneed to conduct a few tests. The most important and essential one is the basic semen evaluation. Here we will explain what this is all about. First of all, here we describe the terminology used to describe nine basicsemen characterstics.
| 1.Normal semen |
Normal volume (1-3 mL), count (20-150 million/mL) and motility. |
| 2.Oligozoospermia |
Fewer than normal numbers of sperms in the semen. |
| 3.Asthenozoospermia |
Low rates of active sperm. |
| 4.Teratospermia |
High rates of abnormal spermatozoon.High rates of abnormal spermatozoon. |
| 5.Oligospermia |
This is the same as #2 |
| 6.Leucospermia |
Too much white blood cells in semen. |
| 7.Necrospermia |
Dead or immotile sperm in the semen |
| 8.Aspermia |
A complete lack of semen |
| 9.Azoospermia |
No sperm in the semen. |
We recommend performing this exam at least twice, because semen findings often change day to day due to different lenghts of sexual abstinence (not ejaculating), and general body or mental conditions.
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| ■Abnormalities found duringbasic semen analysis |
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Some semen findings will suggest that it will be almost impossible to achieve natural fertilization and it will not be possible to improve sperm parameters sufficiently by drug treatment, then assisted reproductive technology (ART) like microinsemination is needed in some case. But normally, we start by assuring appropriatetiming, ie. having sex at the approptiate time for your partner’s ovulation day.. If this treatment does not work after several cycles, we may institute hormone treatments for some cases. At the next step, we carry out AI (choose the best sperm from the semen to infuse into the womb). If that stilldoesn’t work, we may carry out highly assisted reproductive technology called ICSI or microinsemination.
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Immotile or dead sperm are not always the same. There is a possibility that immotile sperm are still alive. Advanced semen exams can determine whether the sperm are alive or dead by using supravital staining (*1).
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*1 Supravital staining
Only living cells can exclude the dye, dead cells take up the dye and will appear in orange.
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| ■No semen ejaculated (Aspermia) |
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Drug therapy, psychological therapy, and occasionally surgical treatment is needed to overcome this problem, and sometime electrical stimulation too. Often retrograde ejaculation is suspected among the patients with no semen but in whom they have the sense of achieving ejaculation. This condition is relatively common among patients having spinal cord injury or with certain surgical history (prostate operation and so on). We diagnose retrograde ejaculation if it is confirmed that sperm are present in your urine when examined after you have the sense that you have achieved an ejaculation. When it is not confirmed, we suspect obstructive azoospermia(*2) or functional azoospermia(*3).
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*2 Obstructive azoospermia
When the Vas deferens are blocked and sperm are not be able to pass through it.
*3 Functional azoospermia
Reduced capacity of the testicle to make sperm.
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| ■No measurable sperm in semen (azoospermia) |
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We suspect obstructive azoospermia or functional azoospermia. In either case, we can take a small sample of testicular tissue out surgically and search for sperm. If there are sperm confirmed, we can use the ICSI procedure to achieve pregnancies. We have already succeeded in establishing pregnancies with ICSI using sperm retrieved from testicles at our clinic.
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In cases of azoospermia (no sperm found in semen) or ejaculatory dysfunction where no other treatments are effective, taking sperm directly from the testicles is possible. We carry out microdissection TESE at our clinic. Specifically, we make a small 1 cm incision in the skin of the scrotum with a scalpel, and collect an extended seminiferous tubule from which we will try to extract viable sperm. Collected sperm will be cryopreservation and used for ICSI after egg retrieval.
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| ■Merits of testicular sperm extraction (TESE) at our clinic |
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【Day surgery】
In the past these procedures required one or two days or hospitalization. Now this is possible as an outpatient procedure only at our clinic. The operation will be over quickly.There are individual differences but usually our operation will be finished in an hour or two.
【Local anesthesia】
Most patients only require local anesthesia above the skin of scrotum. The operation will be performed carefully under control of drip, blood pressure determination, and electrocardiogram. A team that includes two doctors and three full-time nurses, two reproductive technology technicians perform the treatment for TESE.
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| ■Preparations for operation |
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| 1 |
Take a first treatment as a outpatient. (See details CONSULT A DOCTOR) |
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Take semen exam and hormone blood test, and have judgment whether you need TESE or not. |
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When it is decided that you will undergo TESE you need to have a pre-operation exam (electrocardiogram, blood test, chest X-ray). This costs about twenty thousand yen. |
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Take consultation urology as outpatients with partner after resulted of exam. The urologist explains about history taking, manipulation, and TESE concretely. |
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Please not drink or eat in the morning of the operation day. Your operation will start in the morning and will be finished in one or two hours, so that you can leave the clinic in the evening. |
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Next day of the operation. You need to visit us so that we can perform an additional disinfection of the wound and confirmation of frozen sperm. |
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One week later. Remove the stitches from the wound. |
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| ■Q&A about male infertility |
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■Ｑ1．What kind of tests are done during a semen exam?
Ａ１．First of all, a general serum exam will be given. We examine the number of sperms, the rates of activity or abnormality, the numbers of sperm, the pH, number of white blood cells, progressive movement of sperm. Wealsocheck whether any antisperm antibody exist or not, The doctor will explain about each exam in detail at your visit withus.
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■ Ｑ2．Tell me about ICSI.
Ａ2．After selecting morphologically normal sperm from your semen sample, we catch one of them in a narrow pipette and inject it directly into the ovum. General IFV needs about three hundred thousand good quality sperms for each ovum, but ICSI needs only one sperm per ovum to achieve fertilization.
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