Treatment Options

Infertile? Don't be so sure...

Nearly half of our infertility cases involve male problems. We find a high number are not what they first seem to be.

If you or your partner have been told that you have "no sperm" and have been advised to take the donor route, come to us first as we may be able to find what others have missed.

The reason for this is simple.

The basic sperm analysis on which many consultants and clinics base their diagnosis is indicative, but not conclusive.

At Bridge we go one vital step further by offering a complete programme for Male Factor Optimisation (MFO) - a more thorough assessment which includes RCA (Rapid Centrifugal Analysis), a significantly more revealing investigation.

Male Factor Optimisation

Male Factor Optimisation consists of a range of affordable and effective strategies for the most serious male condition, Azoospermia - the absence of sperm as identified at routine semen analysis.

A standard semen analysis is the first stage in any investigation of male infertility. This analysis is indicative but not necessarily conclusive. In our experience, a number of patients diagnosed as infertile do, in fact, have a sperm count but it is extremely low and virtually undetectable. We therefore continue analysis using more advanced techniques.

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RCA (Rapid Centrifugal Analysis)

The second analysis stage uses highly specialised ultra-rapid centrifugal techniques designed to determine the presence of minute quantities of sperm that can be missed in routine testing performed in non-specialist centres.

Frequently, sperm are discovered using these techniques when the situation had previously been thought to be hopeless.

This test may therefore:-

Enable immediate harvesting if there are sufficient sperm present. If this number is 10-20, is possible to proceed to IVF or ICSI, avoiding the need for surgical sperm retrieval.

If, however, fewer sperm are seen, e.g. one or two, their identification will provide reassurance that sperm are in fact being produced by the testis and that surgical sperm retrieval will be possible with a reasonable expectation of success.

In cases of Proven Azoospermia

Once it has been established that sperm cannot be obtained from the semen or ejaculate in sufficient quantities, the next step is Surgical Sperm Retrieval by the techniques PESA or TESE.

Bridge has developed a strategy to minimise the cost of these procedures substantially for most male patients. The procedures are performed in the Bridge Day Care Unit (DCU) by our own experienced team and, by grouping patients requiring this treatment, we have been able to keep theatre and staff costs to the absolute minimum.

Techniques for Sperm Recovery

In most cases the procedure will be performed in the Bridge Day Care Unit. You will be admitted one hour prior to the operation and will be discharged two to three hours later.

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PESA

• The technique called Percutaneous Epididymal Sperm Aspiration, or PESA, is generally used where there is a blockage.
• Under local anaesthetic, sperm is aspirated directly from the epididymis, (the tube containing the sperm), with a very fine needle which has been inserted through the scrotal skin.
• An embryologist will then check the sample under a microscope for the presence of sperm.

TESE

• The technique called Testicular Sperm Extraction, or TESE, is used in cases of non-obstructive azoospermia, or if PESA has been unsuccessful.
• This technique involves the collection of sperm directly from the testis.
• The patient may require an additional injection of intravenous drugs, to achieve a mild degree of sedation.
• A special needle, which allows the surgeon to recover several samples of testicular tissue from different locations, is used.
• A sample from the testicular biopsy will be sent for Histological examination in order to obtain a tissue diagnosis and also to rule out the risk of Testicular Cancer, which is known to occur slightly more frequently (1%) in men with non-obstructive azoospermia.

After the Procedures?

Patients are generally informed on the same day whether sperm has been found or not. However, in the most difficult cases, a two to three day period of tissue incubation is necessary before sperm can be recovered.

Recovered sperm will be frozen for later use. There are generally enough sperm to perform several IVF / ICSI cycles.

The chance of recovering sperm is almost 100% if there is a simple blockage. With abnormalities of the testes, the average recovery rate is around 50% - 60%.

It is therefore important to understand that there is no guarantee of finding sperm even when the pre-operative tests seem encouraging and patients must be prepared for this eventuality.

Immediate Post Procedure Symptoms?

• You will start to feel some discomfort when the local anaesthetic wears off, a couple of hours after the end of the procedure.
• You will be given a prescription for antibiotics and painkillers.
• After a PESA, men are generally able to resume work in a couple of days . Convalescence takes 4-5 days after a TESE.
• In our experience, complications are rare. Whilst some bruising or swelling can occur, this rarely requires additional treatment, although post operative haematoma (a mass of clotted blood in the tissue) has been described in other literature. Furthermore, two cases of post-operative testicular atrophy have been reported worldwide.

Summary of Male Factor Optimisation (MFO) Costs

Initial Semen Analysis	£ 105.00
RCA	£ 365.00*
PESA	£ 1,355.00*
TESE	£ 1,595.00*

* Plus cost of Cryopreservation, see detailed prices - click here

Whatever your needs, our prime concern is for you the patient. Call us to discuss the Bridge formula for success - leading consultants, highly qualified staff, outstanding facilities and a range of affordably-priced treatments - all in one of the most convenient locations in London, right next to the Jubilee, Northern and mainline stations at London Bridge.

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IVF treatment following PESA / TESE?

Sperm extracted surgically is not able to fertilise eggs by routine IVF, so Intra Cytoplasmic Sperm Injection, or ICSI, is essential.

Fertilisation rates are 50-60% and the chance of pregnancy is mainly related to the woman's age and health- our consultant will discuss this with you.

Long Term Sperm Cryopreservation

Men may wish to have their sperm cryopreserved and stored in some circumstances:-

• Prior to undergoing vasectomy.
• Prior to the treatment of some cancer which may involve the removal of a testicle or treatment such as chemotherapy or radiotherapy which may render them infertile.
• In engaged in a hazardous occupation.

Sperm can be stored for a long period of time and used later on for infertility treatment such as insemination of their partner or IVF.

Continue to: Male Factor - Sperm Count >>>>