Male Infertility

Male infertility accounts for approximately 40% of the 2.3 million diagnosed infertility cases in the United States. For this reason, when a couple is experiencing difficulty in achieving pregnancy, a complete semen analysis is a relatively simple and inexpensive test that should be done in the beginning phase of testing. The semen analyis may even be done without a consultation. Treatments for male infertility depend on the specific cause of the infertility and have included surgery, medical treatment and microscopic insemination techniques. Microscopic insemination is laboratory assisted fertilization of an egg.

Male infertility can be associated with the production of low numbers of sperm, sperm that do not "swim" properly or do not swim at all, and sperm that are abnormal in shape. These types of sperm have reduced ability to penetrate the egg. The ICSI procedure has the ability to make low numbers of sperm, "poor sperm motility" and "poor sperm morphology" no longer barriers to couples who seek to have their own biological children.

There are even more severe infertility conditions that can be overcome with ICSI. In some men, the tubes known as the vas deferens that transfer sperm from the testis are blocked or missing through a congenital abnormality, an accident, a disease or an irreparable vasectomy. In such situations, sperm may be obtained by a surgeon from the epididymis, the site where sperm are stored, through a process called epididymal sperm aspiration. In addition, sperm may be obtained directly from the testis, where sperm are manufactured. ICSI makes it possible to use epididymal and testicular sperm to achieve a pregnancy.

There is also unexplained infertility, where for unknown reasons the man’s sperm does not penetrate the woman’s egg even though the number, shape and motility of the sperm all appear normal. ICSI may also be the appropriate treatment in these situations.

ICSI is a way to transfer one sperm directly into one egg. Using a microscope to see the sperm, an embryologist gently draws one sperm into a pipette. The egg is held steady at the end of another glass pipette. Now, with sperm and egg ready, with a steady and measured forward motion, the sharpened tip of the sperm-containing pipette is inserted into the egg. Reversing the process that pulled the sperm into the pipette, the embryologist now ejects the sperm into the egg. And finally, the sharpened tip of the empty pipette is removed from the egg.

Thousands of ICSI procedures have been done successfully. This is not surprising to embryologists for several reasons. First, the egg is many times larger than the pipette that is used to penetrate it’s surface. Second, the human egg is encased in a tough, elastic membrane that does not crack, shatter or crumble. And finally and most importantly, mother nature lends a hand: the egg has the ability to rapidly repair the small hole in its membrane made by the pipette.

Despite widespread use and acceptance, ICSI is still a relatively new procedure. Children born as the result of ICSI are still young and have not yet reached an age to reproduce. Currently there are no reports of increased birth defects or congenital abnormalities in babies born through ICSI. Experts agree that despite its apparent simplicity, ICSI bypasses an important natural barrier: the egg surface. This may permit the transfer of certain male infertility conditions that have a genetic basis. Where a genetic basis to male infertility is suspected or known, the couple may also find it helpful to speak with a genetic counselor before choosing to use ICSI.