When the cause is known
From childhood , some young boys undergo surgery when their testicles have remained abnormally abdominal cavity during fetal life instead of going to scholarships. This condition must be made as it may in fact not only affect the future fertility of these children , but more importantly , to promote the development of testicular cancer .
In the presence of dilated veins in the testicles ( varicocele ) , surgical treatment consists of tying or sealing these veins . This surgery restores fertility in 30-50 % of cases. But beware , 20% of fertile men or not , would present a varicocele , which most of the time , no problem fertility .
Surgery can help restore the permeability of the genital tract . Permeability corresponds to the passage of gametes in the genital tract . Even if it is obtained in 30-60 % of cases, this does not mean a return to fertility. Indeed, many of these men also have abnormal sperm production .
Most andrologues , medical specialists of the male reproductive system , so nowadays prefer to take Amblee sperm in the epididymis for medical assistance to procreation. The surgeon can perform the act of reversal at the same time that the sperm retrieval .
When the cause is unknown
If the semen is not significant and showed no gross abnormalities , the doctor will be concerned about the lifestyle of the patient and offer to :
– Conduct a regular life, with a good fitness
– Avoid heat in the testes: hot baths , briefs or tight pants . For the record, note that the heating briefs have been considered as a contraceptive. In fact, spermatogenesis is optimal when the temperature of the testicles is slightly greater than 37 °.
– Beware of sports such as horse riding or cycling. Creating strain , they could exacerbate the problems of subfertile men.
– Avoid tobacco, coffee, alcohol and overwork .
– Make love often, without falling into an intensive pace that could “tired” sperm and the couple.
This is the oldest method, it benefits from recent advances through research vitro fertilization. It involves depositing sperm inside the female genital tract, provided that one of the two tubes, at least, is permeable.
Artificial insemination is done at an appropriate time in the cycle. If the cycle is spontaneous, the time of ovulation is determined by the LH surge. When the cycle is stimulated ovulation is determined by the intramuscular injection of the hormone HCG. Stimulation of ovulation to create a single or multi-follicular recruitment in the ovaries in the hope of getting between 1 and 3 eggs on average. Normally, a woman produces one egg per cycle. Insemination is made between 24 and 48 hours after the LH surge or after triggering hormone HCG. From the legal point of view, artificial insemination requires an application and consent of the couple.
Artificial insemination of the couple (or IAC) is made with fresh or frozen sperm from the husband. Two scenarios are considered:
– Intra-cervical insemination (or IIC): sperm is deposited in the cervix. Cervical mucus and filter selects the sperm must migrate spontaneously to the interior of the uterine cavity and then to the fallopian tubes.
– Intra-uterine insemination (or IUI) after a preliminary preparation of sperm selection, the ‘good’ sperm are deposited in the uterine cavity, where they are rapidly gaining the fallopian tubes.
This is the occurrence or non-rules and a pregnancy test that indicates whether the insemination is successful.
This technique , practiced since 1982 , is to bring together sperm and eggs , not in the trunk that can not fulfill its fertilization , but outside of mutilation in culture medium favorable to their survival. This method is carried out in a test tube in a test where the failure of “test tube baby .”
This method is performed on request and consent of the couple . The objective is to obtain fertilization and embryo development outside where the term in vitro organization . It is designed for women whose fallopian tubes are blocked and allows direct observation of obtaining fertilization failure or other methods including 4-6 artificial insemination or immediately in women beyond 38years . Several steps are necessary for the proper conduct.
The success depends on the quality and the number of oocytes collected. To encourage the development of ovarian follicles and oocytes get several , most teams use prior to ovarian stimulation by hormone treatment. Prior to stimulate the ovaries are put to rest , to better react .
It looks like an artificial menopause sometimes causing the same unpleasant symptoms , eg hot flushes .
The number is not predictable and rapid development of follicles , medical supervision is essential. It includes , at a steady pace , hormonal blood tests and ultrasounds .
The induction of ovulation
Once maturation obtained was injected hCG to trigger ovulation. The trigger depends on the number and size of follicles and hormonal assays. Warning: it will adapt his schedule to the decision of the doctor who will schedule the date and time of trigger .
The oocyte retrieval should be between 32 and 38 hours after hCG injection. It is vaginally or laparoscopically , using ultrasound . By aspiration, the syringe is emptied every follicle of follicular fluid containing oocytes .
The oocytes were examined in a laboratory reproductive biology that indicates the total number of oocytes , and especially identify those who are likely to be in fertilization .
The semen sample
At the same time , the day of the puncture , the spouse must go to the laboratory to collect his sperm. This sample is taken after about three days of abstinence . It is possible to provide a sperm freezing .
If you are in the case of fertilization with donor sperm bank has previously issued to accredited laboratory ensuring fertilization, flake frozen donor sperm. In all cases, it is the most fertilizing sperm that will be selected.
For these last two steps , one can easily understand that an infectious record must first be made by both partners .
The eggs came with good maturity and sperm ” valiant ” gathered in a biological culture medium conducive to their survival and are kept in an incubator at 37 ° .
24 hours later, when the oocyte has the appearance of a cell containing two nuclei , maternal and paternal , is that there is fertilization. This stage appelle2 PN for “two pronuclei .” The fertilized eggs are returned to the oven and checked under a microscope. 48 hours later, if the fertilized eggs made their first cell division, they develop into embryos.
To facilitate their implementation in the uterine lining , it is possible to extend the in vitro embryo development . They are then placed in an environment providing them with the nutrients that are essential to their development. The embryos can be transplanted between 5th and 7th day of culture or frozen for later transfer .
This is when the embryo leaves the specimen to reach the womb . This is a precious moment , as if we had to file a promise.
It has , in principle , two or three days after the puncture. Or the eggs are placed in a very thin catheter is inserted into the uterine cavity. This gesture is quick, painless , sometimes followed by hormonal treatment. The woman may well return to work within a few days .
Confirmation of pregnancy
This is what everyone hopes . This period is charged with a mixture of hope and anxiety. After having been in constant contact with the medical profession , the couple is alone comes to his own expectations. An assay of the hormone BHCG , made from the 12th day of the transfer indicates if there is or not a pregnancy. If it is positive , it is checked to confirm pregnancy .
ICSI is the most recent method, developed in 1991 by a Belgian team. It represents a major revolution in the treatment of male infertility which, hitherto, had no recourse other than sperm donation. It offers a solution where there is a small number of sperm in the semen, if any. This is when the man has azoospermia, ie an absence of sperm in the ejaculate. That does not mean they do not exist elsewhere. They can then take directly into the male genital ducts and testes.
Concerning the conduct, after stimulation of the ovaries of women, several eggs are aspirated vaginally with a needle and under the control of an ultrasound This technique resembles IVF this time., And this is where is the feat is injected directly, using a micropipette, the sperm into the egg. After 48 hours, the fertilized eggs are placed in the uterus. The pregnancy rate obtained is of the order of 20%.
When the cause is hormonal
In very rare forms of male infertility, there is a disruption of the hypothalamo – pituitary. It requires the equivalent of pituitary hormones, FSH and LH, which gives good results. They are administered as intramuscular injections every two or three days for four to six months.
In addition, a prescription hormone can be considered in order to restore the functioning of the testes.
In other forms of infertility, the results are often unpredictable, but the hormonal treatment can be undertaken to improve the quality of sperm, possibly before an act of artificial insemination.
When the cause is infectious
Infections of the prostate (prostatitis) and sexually transmitted diseases (STDs) should be treated with antibiotics may be prescribed for at least a month.
When the cause is immune
Corticosteroids may be beneficial to overcome the antibodies produced by the man who attacked his own sperm.