Most common male infertility factor is sperm number, motility and morphology disorders (oligo-astheno-teratospermia/OAT). Etiology is usually unknown. If varicosel accompanies OAT, surgical correction is recommended by urologists but its efficacy has not been proved.
If total progressive motile sperm number is > 5 millions, pregnancy can be achieved via insemination. If pregnancy is not obtained after 3-4 insemination attempts, treatment should be switched to IVF.
Azospermia is known as absence of any sperms in the ejaculate. It is either due to the defects of production in the teste sor doe to obstruction in ejaculatory ducts. Cystic fibrosis is diagnosed by gene screening. If there is a mutation in the male, female partner should also be screened. If both parents carry this mutation, the off-spring may be born with the disease.
In males with defective production in the testes, there is either no production or very little amounts of sperm are found in isolated foci. Microinjection is the only way to obtain pregnancy in patients with azospermia. In cases with obstructive azospermia, sperm can be obtained via aspiration of the semen before the point of obstruction (PESA/PTSA). In cases with non-obstructive azospermia, sperm is seeked in the testes by a surgical procedure called TESE. In obstructive azospermia, sperm can be obtained in almost all cases. Among other rare cases of male infertility are impotance, hormonal disorders and ejaculation disorders. For these cases medical treatment is first tried, and IVF is reserved for resistant cases.
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