Male factor infertility accounts for 30 to 40 percent of all infertility cases and includes a problem in either sperm transport or sperm production. Men facing infertility are now benefiting from new non-surgical techniques developed during the last decade that are helping their fertility problems and resulting in excellent birth rates for otherwise infertile couples.
"When chances for fertilization are diminished due to low sperm numbers, in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) can allow normal fertilization to occur," said Kathryn L. Honea, MD, medical director and founder of the ART Fertility Program of Alabama. "Eggs are retrieved non-surgically from the woman and a single sperm injected into each egg for fertilization to occur. One or two embryos are transferred to the uterus non-surgically using ultrasound guidance."
In men who have had a vasectomy, an unsuccessful vasectomy reversal, or infection, scar tissue in the vas deferens or testes can occur and obstruct sperm transport. The same problem can occur in men with cystic fibrosis, which can result in the absence of the vas deferens, and in men who have no sperm in the ejaculate. For couples needing to obtain non-motile sperm, a new procedure — testicular epididymal sperm aspiration (TESA) — can be used to obtain non-motile sperm for IVF.
"With TESA, the sperm is removed directly from the man's testicle with a thin needle biopsy, bypassing the reproductive tract altogether," Honea said. "The sperm is identified immediately and separated from a small amount of tissue through a sterile process called 'teasing.' This process can result in as many as 50 to 100 sperm per procedure. The man is usually able to resume normal activities the next day following this relatively simple and painless procedure. Once the sperm is collected, ICSI is used to inject the sperm into the egg that has been retrieved from the woman through IVF, and the fertilization process begins. Within five days, embryo transfer to the uterus is performed under ultrasound guidance."
According to Honea, the TESA procedure was pioneered in the 1990s by the London Gynaecology and Fertility Centre in England. Cecil A. Long, MD, director of clinical services at the ART Fertility Program of Alabama, trained in London to learn the techniques for this procedure in 1996. "He first performed the procedure upon his return to Birmingham in 1997, and the first baby born using TESA in Alabama is now 10 years old," she said.
The ART Fertility Program of Alabama brought this procedure to the Southeast in 1996, and its physicians report that they have been successful in retrieving sperm in more than 95 percent of cases. They also report no difference in the fertilization rates among males using TESA when compared to males using traditional sperm collection. Pregnancy rates are more than 50 percent per embryo transfer based on the age and ovarian reserve of the woman.
Candidates for TESA include men with:
- Extremely low sperm count
- No sperm in the ejaculate
- A previous vasectomy or vasectomy reversal operation
- No vas deferens
- Scarring of the vas deferens
Brian and Christie Johnson are one of the Alabama couples who have had success with the TESA procedure. Brian, who suffers from cystic fibrosis, said, "Ninety-eight percent of men with cystic fibrosis are born with a vas deferens blockage, or with no vas deferens at all." The TESA procedure was the only way Christie could become pregnant without using donor sperm, something neither of them wanted to do. "Just the fact that this technology exists for couples to be able to get pregnant through nontraditional means is amazing," Christie said.
Christie and Brian welcomed a baby girl, Hayden, in March, and Brian couldn't be more excited. "This is a miracle," he said. "I can't wait to see what the future holds for us."
