Treatment of Male Infertility

Obstructive infertility
Obstructive azoospermia is characterized with normal testes size, normal rate of hormones, deficiency of spermatogenesis in ejaculate, genitalia inflammatory diseases, surgery on organs of scrotum and small pelvis, pathology of adnexas and seminiferous paths during palpation.

Optimal treatment for obstructive azoospermia is microsurgical regeneration of seminiferous paths with single-step obtainment of sperm cells from area before barrier. Obtained sperm cells may be used in ISCI (Intra Cytoplasmic Sperm Injection). Here a number of sperm cells undergo cryopreservation (deep freezing) and they are used in extracorporal fertilization in case of unsuccessful surgery.

Secretory infertility
Most complicated problem when using extracorporal fertilization is treatment of patients with secretory (non-obstructive) form of infertility. This form is characterized with signs of hypogonadism, singular sperm cells or spermatogenesis cells in ejaculate, hormonal shifts, genetic and chromosomal changes.

In secretory azoospermia may be preserved partial spermatogenesis. Thus optimal method of getting sperm cells in non-obstructive azoospermia during ISCI is bilateral multifocal testicular biopsy with usage of microsurgical methods. This is an instrumental control of research of spermatogenesis areas which were kept with the help of test centesis of different testicular areas.

Bilateral multifocal testicular biopsy helps to obtain up to 65% of sperm cells. In non-obstructive azoospermia on the back of hypogonadism (low testosterone rate resulted from hypothalamus pathology) it is necessary to undergo stimulation therapy with gonadotropic hormones.

In frank pathospermia on the back of genetic abnormalities, hypogonadism, obstructive semiology, varicocele is used empiric treatment. Combination of non-obstructive azoospermia with antispermal antibodies is contraindicated for performing stimulation therapy.