Credits

• Section Writer: Dr. Om J Lakhani
• Section Editor: Dr. Om J Lakhani

Q. What causes of infertility are not treatable by conventional Non ART techniques?

• Kleinfelter’s
• Yq microdeletion syndrome
• Sertoli only syndrome
• Germ cell development arrest before primary spermatocyte stage
• Radiation-induced hypogonadism etc

Q. What are the options for the management of such patients?

• TESE / Micro TESE with ICSI
• ART/IUI with Donor sperm
• Germ cell transplantation

Q. In which conditions are specific treatments available with good results?

• Hyperprolactinemia patient- treatment with Cabergoline
• Hypogonadotropic hypogonadism patient – treatment with HCG +/- HMG / Recombinant FSH

Q. Those having increased Leukocyte in the semen, does giving antibiotics helps?

• Those with >1 million leukocyte /ml may have an infection
• Give ten days course of Cotrimox / FQ / Erythromycin
• Repeat test after two weeks
• If WBC is still present- give another ten days course
• The impact on infertility is not well known

Q. What is done for those having sperm antibodies?

• High dose prednisolone 40-80 mg for six months is found to be helpful in such patients
• However, ART is another good option

Q. What is done for retrograde ejaculation?

• Sperm are extracted from the urine after alkalinization of urine and extensive washing of the sperm

Q. In those with varicocele, does repair improve fertility outcomes?

• It is debatable
• Hence it is not recommended at present

Sperm retrieval techniques

Q. Enlist the various sperm retrieval techniques?

• PESA - percutaneous epididymal sperm aspiration
• MESA- Microsurgical epididymal sperm aspiration
• TESA- Testicular sperm aspiration
• TESE- Testicular sperm extraction
• Micro – TESE- Microsurgical- TESE

Q. Which of these are used in obstructive azoospermia?

• PESA
• MESA
• TESA- if above fails
• PESA and MESA are aspirations from epididymis
• TESA- is aspiration from Testis

Q. Which is used for Non-obstructive azoospermia?

• TESE
• Micro-TESE
• TESA- if histopathology is favorable in NOA

Empirical therapy

Q. Which are the various empirical therapy used in male infertility?

• Clomiphene
• Gonadotropins
• Pentoxyphylline
• Vitamin E
• Antiestrogen- Tamoxifen
• Aromatase inhibitors- Letrozole /anastozole

Q. Are these empirical therapies recommended?

• No

ART

Q. Which is the best ART technique for male factor infertility?

• ICSI
• Pearl
• IVF- Better for non-male factor infertility
• ICSI- better for male factor infertility

Q. Summarize the management of infertility in various conditions which work?

• Hyperprolactinemia- Cabergoline
• Hypo hypo HCG / HMG, Pulsatile GnRH
• Obstructive azoospermia – repair of obstruction. If not, then PESA / MESA with ICSI
• Non-obstructive azoospermia / Kleinfelter’s- TESE/ Micro TESE with ICSI