Frequently asked fertility questions

Possible treatments
If the lack of sperm is due to a tubal obstruction, then it may be possible to undertake surgery to clear the obstruction. It can be possible to remove a varicocele from the testes, which may then result in improved sperm motility.

Drugs (e.g. Tamoxifen) may be recommended to boost sperm production, treat hormonal imbalances. Infections, usually arising from the prostate gland, may damage sperm motility and should be treated with antibiotics.

Vitamins are sometimes prescribed, either separately or as a combined tablet. Vitamin C, Vitamin E, Vitamin A, Vitamin B9 and Zinc are all required for sperm production.

The following assisted reproductive techniques may be used when there is male factor infertility:

• IUI (intrauterine insemination) involves the sperm being collected, washed and then placed by catheter in the uterus, where it is left to fertilise an egg naturally
• IVF (in vitro fertilization) involves combining eggs with sperm in a laboratory. The eggs are combined with prepared sperm overnight for fertilization, and the resulting embryos are then transferred to the uterus. Normally a sperm count of at least 3 million is required
• ICSI (intracytoplasmic sperm injection) is similar to IVF, but a single sperm is injected directly into a retrieved egg. The egg is then incubated and transferred to the uterus

If the lack of sperm is due to an obstruction which cannot be cleared through surgery, congenital absence of the vas deferens, failed vasectomy reversal, or inadequate sperm production, then the following procedures may be considered:

• MESA (micro epididymal sperm aspiration) is a technique where a surgeon gathers sperm from the epididymus
• PESA (percutaneous epididymal sperm aspiration) is similar to MESA but does not involve micro-surgery. A fine needle is used to extract the sperm in a syringe from the epididymus
• TESE / TESA (testicular sperm extraction) involves multiple fine needle biopsies to remove tiny samples of tubules containing sperm

PESA and TESE/TESA are usually performed under a local anaesthetic and take about 30 minutes to perform. MESA requires a general anaesthetic. Sperm that has been collected surgically can then be used for ICSI.