Penn Fertility Care

Male Infertility

Treatments

Male infertility treatment options include:

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a procedure that has revolutionized the treatment of male infertility. During this procedure, a single sperm is injected directly into the partner's egg. As a result, men with a failed vasectomy reversal or with a congenital (from birth) absence of the vas deferens now have a high chance of fatherhood without using donor sperm. This procedure has decreased the need for donor sperm and almost eliminated the concept of untreatable male infertility.

Intrauterine Insemination (IUI)

Intrauterine insemination is a relatively "low-tech" assisted reproductive technology (ART) that involves depositing a large number of specially processed sperm into the uterus at the optimal point in the menstrual cycle.

A normal ejaculate contains over 40 million sperm. Of this large number, only a few hundred will reach the fallopian tubes. If there is not enough normal sperm produced within an ejaculate, then there may be too few sperm reaching the fallopian tubes. IUI's intent is to create a higher concentration of sperm in the fallopian tubes to increase the likelihood of fertilizing an egg.

Learn more about intrauterine insemination

Azoospermia Services

Azoospermia can cause serious problems with sperm production and transfer, ultimately preventing a man's sperm from entering his ejaculate. This can make pregnancy very difficult, if not impossible.

Men with azoospermia generally have no symptoms and the condition can only be diagnosed through a sperm count. There are two types of azoospermia:

Obstructive Azoospermia

Occurs when a blockage in the duct system prevents sperm from mixing with semen. These obstructions may be present in the vas deferens or epididymis and account for 40 percent of azoospermia cases.

Non-Obstructive Azoospermia

Occurs when there is a problem with the body's production of sperm. It is often the result of hormonal imbalances. Non-obstructive azoospermia accounts for 60 percent of azoospermia cases.

Penn Fertility Care works in collaboration with Penn Urology to offer the latest techniques in treating azoospermia. These include:

PESA

Percutaneous epididymal sperm aspiration, a procedure for men with either congenital or acquired obstructions causing an absence of sperm in the ejaculate (obstructive azoospermia). This procedure involves local anesthesia and does not require an incision or hospitalization. The amount of sperm collected through PESA is sufficient to assure the fertilization of an egg and for freezing. PESA is less expensive than other infertility procedures and offers the patient a quick recovery.

TESE

Testicular sperm extraction, a procedure for men who do not have sperm in the epididymis. TESE is an effective procedure used to retrieve sperm by performing a testicular biopsy. The testicular biopsy is a minor surgical procedure and can be performed on an outpatient basis.

Both of these procedures allow doctors to freeze unejaculated sperm for future use.

Vasectomy Reversal

A vasectomy reversal is a surgical procedure used to reverse the effects of a vasectomy. Approximately 5 percent of American males undergo a vasectomy. Of that number, some 2-3 percent choose to reverse the procedure.

If the reversal is performed within 10 years of the vasectomy, the rate of successful reversal is about 60 to 75 percent. After 15 years, however, it drops to about 30 percent. Fortunately, surgical reversal is no longer the only way to obtain sperm from men who have undergone a vasectomy. With PESA and TESE procedures, Penn Fertility Care is able to obtain sperm about 98 percent of the time.

Varicocele Services

Incompetent or inadequate valves within the veins along the spermatic cord cause a varicocele. The abnormal valves obstruct normal blood flow causing a backup of blood, resulting in enlargement of the veins. Varicoceles usually develop slowly and usually have no symptoms. Varicoceles are a common cause of infertility in men.

The main technique for treating a varicocele is called internal spermatic venography and embolization. This radiological procedure involves plugging the affected vein with a coil. It is similar to a needle puncture to draw blood, requiring only a local anesthetic. Both the right and left sides can be fixed through one puncture. Patients can return to normal activities within 48 hours. Correction of the varicocele frequently improves the likelihood of pregnancy.

To learn more about varicocele and varicocele embolization, visit the Penn Interventional Radiology website.

Urology

Penn Fertility Care works in conjunction with the Male Fertility Program and Microsurgery Section in the Division of Urology at the Hospital of the University of Pennsylvania. Penn experts have extensive clinical experience in male infertility and have particular expertise in microsurgical reconstruction of the male reproductive tract.

Penn Urology offers the following services:

  • Scrotal ultrasound
  • Transrectal ultrasound
  • Endorectal MRI
  • Doppler studies
  • Vasectomy reversal
  • Varicocele surgery (vasovasostomy or vasoepididymostomy)
  • Seminal vesicle surgery
  • Transurethral resections for ejaculatory duct blockage

For more information, please visit Penn Urology

Paraplegics and Male Infertility

Penn Fertility Care uses two methods to obtain sperm from paraplegics who have either failed or do not want to try electroejaculation and vibratory stimulation. One technique is testicular sperm extraction (TESE) and the other technique is called seminal tract washout (STW). With this method, sperm is flushed from the vas deferens into the bladder where it is collected.