The male genital tract includes the testes, the epididymis, the vas, the prostate and urethra. The testes situated in the scrotum are mainly made up of loops of fine tubes (seminiferous tubules) which produce the sperm. The sperm cells mature as they pass through the epidiymis (a narrow system of tubes on the surface of the testes). The vas is a hollow tube, which carries the sperm from the epididymis to the urethra.

It takes 3 - 4 months for sperm to develop, during this time sperm production may be affected by febrile illness, exposure to drugs, toxins, radiation, local trauma or infection.

The primary laboratory test for male fertility is " semen analysis". The sample is obtained by masturbation or collected from a special condom following intercourse. Sterile containers must be used to collect the sample following three days of sexual abstinence.

A normal assessment should show :

• Semen volume - 2-4mls
• Sperm count - more than 20 million per ml
• Sperm motility - more than 50% moving
• Sperm morphology - more than 30% of normal shape
• White blood cells - should be less than 1 million per ml
• Antisperm antibodies test - should be negative

Common Male Infertility Problems :

• Abnormal Sperm parameters :
  Low sperm count - (oligospermia)
  Poor sperm motility - (asthenospermia)
  High abnormal forms - ( teratospermia)
  
• Immunological factors : - Antisperm antibodies may occur following surgery, trauma or infections of the genital tract. Antisperm antibodies impair sperm motility and their ability to penetrate and fertilise an egg.
   
• Absence of Sperm : - (azoospermia) May be due to an obstruction at the level of the vas, epididymis, or even the testes, caused by previous infections, trauma or surgery. It may also be due to a bilateral congenital absence of the vas. Azoospermia could also be due to testicular failure caused by hormonal, chromosomal abnormalities, previous infection such as mumps or undescended testes.

A single sperm consists of a head, which contains the man's genetic information and its tip, an acrosome which will help the sperm penetrate the outer shell of the egg; a midpiece, which supplies the energy needed for movement; and the tail which propels the sperm forward.

In Vitro Fertilisation - IVF may be used for certain types of male infertility, such as those with slightly reduced sperm counts or anti-sperm antibodies, a form of immune infertility, with IVF relatively fewer motile sperm are required for oocyte fertilisation because the natural transport barriers are bypassed; moreover IVF increases the number of sperms in contact with multiple oocytes from superovulation. However there now exist a number of more specialised options for treating severe male infertility.

Intracytoplasmic sperm injection (ICSI) - This technique involves the use of micromanipulators to inject a single sperm into each egg.  It is used for cases where very few functional sperm are available, for patients who have previously failed to achieve fertilisation with IVF, for patients with known functional sperm defects and for patients who require surgical sperm retrieval.

Intracytoplasmic Sperm Injection (ICSI) 

ICSI has revolutionized the treatment of severe male factor problems, especially when the sperm is surgically retrieved.

Donor Sperm Insemination - DI Donor Insemination

Intrauterine insemination with the use of donor sperm may be indicated when the male partner's sperm is severely suboptimal. This treatment will always be an option in severe cases of male factor infertility, azoospermia or genetically transmitted disease.

Surgical Sperm Retrieval - (SSR)

This is a technique for collecting immature sperm directly from the vas, epididymis or testes. Sperm retrieval may be performed under local anaesthetic, as an out patient procedure, under general anaesthetic or during another operation to repair an obstruction in the vas. In this case a man has no sperm in his ejaculate, surgical sperm retrieval may be used to extract sperm from various parts of the male reproductive tract, most frequently from the epididymis ( percutaneous epididymal sperm aspiration - 'PESA' ), or directly from the testicles ( testicular sperm aspiration - 'TESA' or testicular sperm extraction - 'TESE' ). These techniques must be used in conjunction with intracytoplasmic sperm injection (ICSI), as sperm retrieved in this way are immature, and are incapable of fertilisation without assistance.

Spermatozoa. 

PESA - Percutancous Epididymal Sperm Aspiration.

TESE - Testicular Sperm Extraction. If sperm are not found, a sample of tissue (testicular biopsy) can be taken from the testes through a small incision, 2 - 3 stitches are placed in the skin which self dissolve in about 10 days. Once the sperm have been collected, fertilisation is achieved using Intracytoplasmic Sperm Injection (ICSI.) This involves injecting a single sperm directly into the egg. Excess sperm from the sample can be cryropreserved for possible future use.

Rectal-electroejaculation

This technique is used to obtain sperm from spinal injured or otherwise impotent men. These sperm can be used for intrauterine insemination, IVF or ICSI, depending on the quality.