Male Infertility

ICSI

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is the process of injecting a single sperm into an egg. This revolutionary technology enables fertilization in cases where the male partner has low sperm production or motility that cannot be addressed surgically (‘severe male factor infertility’); and in cases where basic in vitro fertilization (IVF) treatment has been unsuccessful. ICSI is always necessary in cases where sperm is surgically removed from the testicles (MESA and TESA procedures).

 

Since it was first used in the early 1990’s, there have tens of thousands of children born after having been conceived with the use of ICSI. In 2007, 63.5% of all IVF cycles in the United States involved the fertilization of eggs by ICSI.

ICSI and IVF
Fertilizing eggs through ICSI
  • The embryologist removes follicle cells surrounding each egg using an enzyme solution. This is necessary to make sure the egg is mature enough to be injected and for the embryologist to see what they are doing, and so that the egg can be gently grasped for the injection procedure.
  • Each egg is held by gentle suction in a glass pipette.
  • A single sperm is injected through the shell of the egg via a tiny, glass microneedle.
  • The sperm is deposited deep into the innermost part of the egg (cytoplasm) and the needle is withdrawn.

Male Infertility Treatment

For Patients in All Across the India

Perhaps because the woman carries the baby, we often consider infertility solely a female problem. In fact, up to 50 percent of all infertility cases involve the male partner. If male fertility issues are suspected based on the results of a semen analysis, we may refer him to a male fertility specialist or an andrologist, who specializes in male reproductive problems. Just as reproductive endocrinologists are gynecologists sub-specialized in treating female infertility, andrologists are urologists specially trained to treat male infertility.

 

As with female infertility, there are a number of treatments to successfully address various male infertility diagnoses. When recommending a given male fertility treatment option, we consider three important factors:

 

  • Cause of infertility, if identifiable
  • Severity of the sperm abnormality
  • Age of the female partner

Because male infertility may require months of treatment, any treatment plan will consider age of the female partner, as this is a crucial element in fertility success.

The male fertility evaluation will include a sperm count, and usually a panel of hormone blood tests, a physical and urogenital examination, and possibly genetic tests and/or sperm function testing. Learn more about diagnosis of fertility problem.

Genetics and Male Infertility

The development of in vitro fertilitzation (IVF) has allowed many couples to have the families they might otherwise have been unable to create independently. At the same time, this technology has allowed researchers to study the genetic make-up of the earliest stages of embryos. These advances are providing insights into the link between genetics and infertility and how defects (mutations) in specific genes may result in male or female infertility. It is possible that many cases of unexplained infertility will one day be found to have a clear genetic basis.

 

What has been learned in the last two decades of assisted reproduction is that some cases of severe male factor infertility are clearly related to gene deletions, mutations or chromosomal abnormalities.

Chromosome abnormality

Some men with very severe male factor infertility will be found, upon testing their blood chromosomes (known as a “karyotype”) to have an extra X chromosome. That is, instead of having a 46 XY karyotype, they have a 47 XXY karyotype. This condition is known as “Klinefelter Syndrome” and can result in failure to achieve puberty or even when puberty is achieved, these men often have male infertility. Some men with Klinefelter Syndrome can father pregnancies through the use of in vitro fertilitzation (IVF) with Intra-Cytoplasmic Sperm injection (ICSI). So far, we are not seeing an increased risk of Klinefelter Syndrome or other chromosome abnormalities in the offspring achieved in these cases.

Y chromosome micro-deletions

Also discovered in recent years is that some men with very severe low sperm counts will be found to have deletions in a certain part of their Y chromosome, known as the DAZ gene. Their karyotype is normal (46 XY) but close inspection of the Y chromosome shows there are sections of the chromosome that are missing. A portion of these men will have no recoverable sperm in the ejaculate or on testicular surgery and donor sperm is the only option. With other deletions in the DAZ gene, there is a small amount of sperm present and conception with IVF-ICSI is possible. In these cases, the male offspring which will always inherit their father’s Y chromosome, will also have this deletion, and will themselves be infertile.