Male Sexual Dysfunction and Infertility
B. EJACULATORY DUCT OBSTRUCTION (EDO)Ejaculatory ducts are paired tubes that begin near the vas deferens behind the prostate and next to the seminal vesicle, course through the prostate and empty into the prostatic urethra. The openings if blocked, can lead to low semen volume and infertility.
Diagnosis of EDO:• Semen analysis shows low semen volume, low or absent sperm counts and motility and absent fructose in semen.
• Transrectal Ultrasound: shows dilated seminal vesicles and dilated ejaculatory ducts
Treatment of EDO:• TURED(Trans Urethral Resection of Ejaculatory Ducts): A procedure done through the urinary passage under anesthesia, where openings of the ejaculatory ducts are de-roofed . You can go home the same or next day.
• Vaso-Vasostomy: Blockages of the vas (sperm duct) ismost commonly seen post vasectomy & can be overcome with vasectomy reversal(Vaso-Vasostomy) by reconnecting the two end of vas deferens to allow for passage of sperm during ejaculation.
• Micro Vaso-Epididymostomy(Micro-VEA): Blockages to the epididymis may be overcome using microsurgical epididymo-vasostomy.
WHAT TO DO IF BOTH MEDICAL AND SURGICAL MANAGEMENT FAILS?Assisted Reproduction Techniques(ART)
1. INTRA UTERINE INSEMINATION(IUI)
This involves collecting the semen from the male by masturbation, washing it in lab and introduction into the female genital tract using a special syringe. It is done under ultrasound guidance and is an outpatient procedure and does not require anesthesia. This technique indicated for low sperm quality, immunologic infertility and for men with mechanical problems with sperm delivery (e.g. erectile dysfunction). The success rates vary widely ranging from 8-16% and more than 3 cycles may be required.
2. IN-VITRO FERTILIZATION(IVF) AND INTRA CYTOPLASMIC SPERM INJECTION(ICSI)
IVF (Test tube baby) involves ovarian stimulation and egg retrieval from the ovaries prior to normal ovulation. Eggs are fertilized in lab with sperm. Fertilized eggs or embryos are then transferred to the female genital tract through a simple vaginal procedure. IVF can bypass moderate to severe forms of male infertility in which low numbers of motile sperm are present.
In ICSI, the sperm is directly injected into the egg (ovum) with a microscopic needle in the lab. This is called as sperm “micromanipulation” and has helped with the treatment of male infertility. Even one viable sperm is sufficient for ICSI. So it is possible to achieve pregnancy even in the most severe cases of male infertility. It has pregnancy rates of 30-40% per cycle.
HOW TO RETRIEVE SPERMS FOR IVF IF NO EGGS FOUND IN EJACULATE IF OBSTRUCTION CANNOT BE TREATED?Sperms can be retrieved directly from testis or epididymis by a urologist using following techniques:
1. TESA: Testicular Sperm Aspiration.
2. TESE: Testicular Sperm Extraction.
3. PESA: Percutaneous Epididymal Sperm Aspiration
4. Micro-TESE: Microsurgical Testicular Sperm Extraction
What to do if no sperms can be found?Donor insemination (DI)
Donor semen is carefully screened for infections and a donor selected to have similar attributes to you. This is the only viable option if you have no sperms at all and you do not have obstruction which can be relieved surgically.
If you do not to have any success with other treatments, you may wish to consider adopting a child.
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