Recent studies have shown that male infertility is on the rise due to decrease in the average sperm count. This can be attributed to genes, infections, lifestyle changes, smoking, drug abuse, mental stress due to pressures at work, obesity, hypertension, and environmental and pesticide pollutants. This means more and more males will become infertile and will have to resort to medical, surgical and assisted reproductive treatment to help their partners conceive.
Over the past 30 years, the treatment for infertility has seen the development of revolutionary new assisted reproduction techniques like in-vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSCI). These highly complex techniques are used with increasing frequency in the treatment of couples around the globe. More than one million babies worldwide have been conceived by these new techniques. Both IVF and ICSCI involve conception in a test tube and hence bypass natural conception. There is therefore a risk of undesirable genetic traits being passed on to the next generation.
IVF and ICSI are also advised in males who have a poor sperm count and in whom medicine or surgery cannot help to improve the count. However, recent technological advances have enabled the use of robotics and microsurgical assisted techniques to improve sperm counts. This helps conception in a more natural form and avoids the use of IVF and ICSCI when the male is responsible for the lack of conception in an infertile couple. The infertile men either have a low sperm count (Oligospermia) or have no sperms in the semen (Azoospermia).
When azoospermia is due to a block in the tubes (epididymis, vas deferens, ejaculatory duct) transporting the sperm, it can be cured surgically by advanced techniques called vasovasostomy, vasoepididymoanastomosis or seminal vesiculoscopy. These surgeries are very delicate and time consuming as they involve operating on structures smaller than the heart vessels.
With advances in microsurgery and robot assisted microsurgery, the chance of sperm reappearance rate can be as high as 80 per cent. Without the use of these techniques the chances of sperm reappearance is as low as five per cent. The advantage of microsurgical reconstruction is that once successful, natural conception is possible without the agony of going through multiple IVF or ICSCI cycles.
In oligospermia (low sperm count) due to poor sperm production either due to the enlarged veins surrounding the testes (varicocele), microsurgery allows a success rate of almost 60 per cent (pregnancy rate). In cases where the low sperm count is due to disease in the testes; microsurgical sperm retrieval (micro-dissection TESE) techniques can find sperm in testis. In conclusion, recent advances in robotics and microsurgical techniques have given new hope to an infertile male to conceive in a more natural way.
The writer is consultant Urologist at Dr Ramayya’s Urology and Nephrology Institute and Hospitals, Hyderabad.