REPROSAIT 4 U

Approximately one in five couples have trouble conceiving a child. If a couple is unable to conceive after one year of unprotected intercourse, they are said to be subfertile. Around 40 per cent of fertility problems originate in the man, with causes including sperm abnormalities and blockages within structures of the reproductive system, such as the vas deferens. Many men have sufficient sperm to fertilise their partner's eggs in a test tube, even if they are unable to do so during sexual intercourse. In most cases, the couple can be helped with assisted reproductive technologies. For around one in 10 couples investigated for infertility, no cause is found. This is known as 'idiopathic infertility'.

Diagnosis methods
Investigating suspected infertility requires a range of tests for both the man and his partner. Some of the tests the man may undergo include:

• Physical examination - including medical history.
• Ultrasound scans - to check the health of reproductive organs.
• Blood tests - to check sex hormone levels.
• Semen analysis - a sperm sample is checked for abnormalities and antibodies.
• Testicular biopsy - the fine network of tubes within the testicles is checked for the presence of sperm.

• Surgery
• Hormone therapy
• Artificial insemination
• In vitro fertilisation (IVF)
• Intra cytoplasmic sperm injection (ICSI).

Surgery
Fertility may be impaired by varicocele, or the bloating of veins inside the testes. This condition can be surgically treated. The tubes within the male reproductive system that transport sperm may be blocked, perhaps by injury or vasectomy. In some cases, the blockage can be surgically removed or the tubes repaired. If this doesn't work, the man may undergo another surgical procedure called percutaneous epididymal sperm aspiration (PESA). Under local anaesthetic, a slender needle is inserted into the epididymis, which is the tube at the back of the testicle that collects and stores sperm. Sperm is removed, and either used immediately for IVF or frozen.

Hormone therapy
The pituitary gland in the brain releases the hormone gonadotropin, which prompts the testicles to produce sperm. In a small number of cases, male infertility is caused by insufficient levels of gonadotropin. Taking a synthesised version of this hormone can boost sperm production.

Artificial insemination
The man's semen is collected, washed and concentrated, then introduced (via instruments) into his partner's vagina, cervix, uterus or fallopian tubes, depending on the circumstances. This option is often chosen if the husband has functional problems (such as impotence), or if his sperm can't make it through the cervix to the uterus. Some of the factors that can stall sperm at the entrance to the uterus include:

• The man's seminal fluid contains antibodies that destroy his sperm
• The cervical mucus contains antibodies that destroy his sperm
• The cervical mucus is so acidic that sperm are unable to survive.

In vitro fertilisation (IVF)
In vitro fertilisation (IVF) is conception within a test tube (or similar). The woman undergoes ovulation induction (hormonal stimulation of her ovaries) and a number of eggs are removed. This is done through the vagina under ultrasound control. The collected eggs are then mixed with sperm previously collected from the woman's partner, and placed in a special incubator. The fertilised eggs are then implanted into the woman's uterus via a thin tube inserted through the cervix.

Intra cytoplasmic sperm injection (ICSI)
Sometimes, semen contains too few sperm to make fertilisation possible through IVF. In this case, intra cytoplasmic sperm injection (ICSI) can be used. The eggs are removed from the woman's ovaries, then individually injected with a single sperm each. When the eggs are fertilised, the embryos are transferred into the uterus.

Figure 1:
Immobilizing the sperm's tail before picking it up.

Figure 2:
Injection of sperm into the egg.

Figure 3:
Fertilized egg demonstrating the two nuclei – one from the father, one from the mother.

Pregnancy isn't always possible
Despite the sophistication of assisted reproductive technologies, pregnancy doesn't always happen. It depends on a range of factors, including the type of technology used and the reasons for the man's infertility. It should be remembered that assisted reproductive technologies can't improve the quality of sperm. Azoospermia, for example, means that the man's semen doesn't contain any sperm at all. In such cases, donor insemination may be considered. This involves artificially inseminating the partner with sperm from an anonymous donor.

Things to remember

• Around 40 per cent of fertility problems originate in the man, with causes including sperm abnormalities and blockages within structures of the reproductive system, such as the vas deferens.
• Some of the reproductive technologies available to infertile men include surgery to clear blockages, hormone therapy, artificial insemination, in vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI).