by Dr Agilan Arjunan, Fertility Specialist & Gynaecologist, KL Fertility Centre (Malaysia)
Which Infertility Treatment Will I Need ?
Treatment options can be divided into treatment for male infertility and treatment for female infertility.
Reduced sperm quality.
According to world standard (World Health Organization) , sperm quality is taken as ‘normal’ when the sperm concentration is > 15 million/ml, motility is > 40% , normal form is > 4% , vitality > 58%.
When the semen analysis shows values less than this, it is considered ‘low’ in sperm quality. How to improve sperm quality?
Treatments that can be offered are lifestyle changes (such as stop smoking, reduce alcohol intake, reduce weight and stress) and oral medication called anti-oxidants.
Research had shown that high level of reactive oxygen spesis (ROS) and low level of antioxidant in the semen reduces sperm quality. Supplementing men with oral antioxidants improves sperm quality especially motility. There are many antioxidant such as vitamin C, vitamin E, L-carnitine, Co-enzyme Q, zink and selenium. Your doctor will give a combination of these antioxidants.
2. Azospermia ( no sperm)
When there is no sperm found, it could be due to obstruction in the channel that sperm passes through (vas deferans) or due to low or no sperm production in the testis. Your doctor will do some blood test on male partner and examine the testicles to arrive to a diagnosis.
Obstruction can be caused by infection or injury to testicles . Sometimes the men is born without vas deferens. It can also be due to previous vasectomy (male sterility procedure).
There are several options to retrieve the sperm:
For men with previous vasectomy, a vasectomy reversal surgery can be done. However, the success rate is low. If the reversal surgery failed, PESA or TESE / TESA can be done .
If obstruction is diagnosed, PESA (Percutaneous Epididymal Sperm Aspiration) can be done. In this procedure, sperm is directly aspirated from epididymis (where sperm is stored in the testis) using a fine needle.
If obstruction or low sperm production is suspected, TESE ( Testicular Sperm Extraction) or TESA (Testicular Sperm Aspiration) can be done, where a biopsy or several biopsies taken directly from the testis after making a small incision in the scrotal skin.
Tubal factor infertility means that there is a problem for the egg / oocyte to pass through the Fallopian tube to meet the sperm. It includes a diseased or surgically removed) unilateral (one) / bilateral (both) Fallopian Tubes or absence of Fallopian tubes. If 1 (one) of the fallopian tubes are open/patent, much simpler treatments such as Timed-sexual intercourse or Intrauterine Insemination (IUI) can be done. If both the Fallopian tubes are not patent or absent, IVF is needed.
If the fallopian tubes are swollen, you may need a laparoscopic (keyhole) surgery to remove the diseased fallopian tube.
If the woman is not ovulating, such as in women with Polycystic Ovarian Syndrome (PCOS), fertility pills (ie Clomid) can help. It is normally taken for 5 days starting on Day 2 of menses. Together with fertility pills, Timed Sexual intercourse or IUI can be done. If these methods are not successful, IVF/ICSI is needed.
3. Uterine / Ovarian / factor
Sometimes there is a problem or pathology with uterus or ovary. Problems with uterus are presence of uterine fibroid , abnormal uterine shape (ie bicornuate uterus), presence of intrauterine adhesions (synaechia) or intrauterine septum. Problems with ovary could be presence of ovarian cyst or polycystic ovary (PCO). Many of these conditions are treatable with surgery, especially laparoscopic (keyhole) surgery. Depending on the problem and the success of surgical treatment, Timed Sexual Intercourse , IUI or IVF/ICSI can be tried.
4. Unexplained Infertility
This is a little bit more tricky to treat since there is no cause found. Generally treatment will depend on the female partner’s age, duration of infertility and the couple’s wishes. Generally, IUI or IVF/ICSI will be needed in this situation. More detailed discussion of the treatment options for couple in this category will be done by your fertility specialist.