Male Factor Infertiltiy

Approximately 30 - 40% of infertility is related to male factors. The standard test for evaluation of a man's fertility is the semen analysis. This test measures the volume, concentration, motility, morphology (appearance of the sperm), and antisperm antibodies in the semen sample. All male patients are required to have a semen analysis regardless of any known problems with their partner.

	IUI (intrauterine insemination)
	TDI (therapeutic donor insemination)
	ICSI (intracytoplasmic sperm injection)
	PESA (percutaneous epididymal sperm aspiration)
	MESA (microscopic epididymal sperm aspiration)
	Testicular Extraction of Sperm (TESE)
	Vibrostimulation / electroejaculation
	Retrograde ejaculation

Intrauterine Insemination of Sperm (IUI)

Intrauterine insemination (IUI) of sperm is a fertility enhancing treatment whereby specially "washed" sperm are placed in the uterine cavity at the time of ovulation using a small sterile catheter. This treatment is used for treating mild male factor infertility, unexplained infertility and for inseminating donor sperm. Clomiphene Citrate/IUI, Superovulation/IUI, Sperm Wash/IUI

Therapeutic Insemination of Donor Sperm (TDI)

This treatment is used for treating male factor infertility and also for insemination of single women and same sex couples. The Regional Fertility Program currently purchases sperm from commercial banks. Donors enrolled in these programs are volunteers but are only allowed to donate after careful screening for genetic, psychological and infectious diseases. They must have good quality sperm that will survive the freezing and thawing process in good condition. The collection, processing, distribution and use of donor sperm in Canada are regulated by Health Canada.

Based on current research, it is the practice of the Regional Fertility Program not to permit the use of a sperm donor that would result in a future child appearing racially different than the recipient or the recipient's partner.

Intracytoplasmic Sperm Insertion (ICSI)

Intracytoplasmic Sperm Insertion (ICSI)

Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous epididymal sperm aspiration is a procedure to obtain sperm from the epididymis. This technique is used for men who have had a prior vasectomy and in those who have a congenital or acquired obstruction of the genital tract such as absence of the vas deferens. PESA is normally performed in our clinic under local anaesthesia. The sperm retrieved can only be used for in vitro fertilization using intracytoplasmic sperm insertion (ICSI).

Microscopic Epididymal Sperm Aspiration (MESA)

Microscopic epididymal sperm aspiration is an operative procedure used to obtain sperm by opening the ducts in the epididymis. MESA is performed in the operating room under local or general anaesthesia. This technique is used for men who have had a prior vasectomy and in those who have a congenital or acquired obstruction of the genital tract such as absence of the vas deferens. This technique is often performed when PESA (percutaneous epididymal sperm aspiration) has been unsuccessful. This sperm can only be used for in vitro fertilization using intracytoplasmic sperm insertion (ICSI).

Testicular Extraction of Sperm (TESE)

Testicular sperm extraction involves removing tissue from the testicle itself through a small incision in the scrotum or by using a special biopsy instrument. The testicular tissue is then dissected to release the sperm that are present in the seminiferous tubules. This procedure is generally used when other methods of retrieving sperm have not been successful.

Vibrostimulation / Electroejaculation

Men with spinal cord injuries, neurological disorders, diabetes and post surgical ejaculation problems can usually have vibrostimulation or electroejaculation procedures to retrieve sperm. The sperm can sometimes be used for artificial insemination but due to low numbers, the sample can only be used for in vitro fertilization and ICSI (Intracytoplasmic Sperm Insertion).

Vibrostimulation is a procedure performed using a special vibrator applied directly to the penis. When successful the ejaculate is collected in a sterile container and may be used for artificial insemination or in vitro fertilization. Vibrostimulation is typically used as a first line procedure for patients with a high spinal cord injuries and is some men with ejaculatory disorders.

Electroejaculation is a procedure whereby a special probe is inserted into the rectum to stimulate the pelvic nerves and cause ejaculation to occur. This procedure is usually successful and the sample is collected in a sterile container which may be used for artificial insemination or in vitro fertilization. Electroejaculation is usually required to retrieve semen samples in men with spinal cord injuries. It can also be used for other ejaculatory disorders.

Retrograde Ejaculation

Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation. In this condition little or no semen is discharged from the urethra at the time of orgasm. Under some circumstances sperm retrieved for the bladder urine can be washed and used for artificial insemination or intrauterine insemination. This procedure involves initial catheterization of the bladder prior to producing the ejaculate to place special media that preserves the motility and viability of the sperm and subsequent bladder catheterization post orgasm to retrieve the ejaculate.