Clinical Andrology
Don't give up on the family you dream of: increase your chances of becoming a father.
Male infertility
The international scientific community agrees in speaking of infertility for the couple who, after two years of unprotected intercourse, did not achieve pregnancy. The problems are traced back to the woman, the man, the couple themselves and to causes with no apparent explanation. However, the male component represents a constantly growing percentage.
In men, the reasons for temporary or permanent infertility are related to hormonal disorders, general diseases, trauma or obstructions of the reproductive structures, sexual dysfunctions and, increasingly often, inflammatory processes.
Some of these situations become more time-consuming and difficult to treat and resolve the longer they remain ignored, underestimated and not adequately treated. It is important not only to stimulate a greater culture of prevention in men, but also to have specialists and a laboratory dedicated to the analysis and diagnosis of male reproductive capabilities available.
Infertility diagnosis
The main reasons for infertility in men are connected to the production of semen and its release. The causes and risk factors can be hormonal, secretory testicular, excretory testicular, ejaculatory and immunological.
In the diagnosis process, Next Fertility ProCrea specialists analyze the man’s history and lifestyle: pathological and therapeutic events but also habits (for example smoking and alcohol abuse alter sperm production) can influence on reproductive capabilities. Instrumental investigations for successive levels of complexity allow us to identify the problem and establish the path to follow for a possible solution
Dr. Giovanni M. Colpi is former founder of the Institute for Sterility and Sexuality of Milan (www.istitutoises.it), where he trained many of the students, who worked under him in public institutions of which he was Director, in male infertility. He is now considered one of the leading international experts in the surgical management of azoospermia and cryptozoospermia through MicroTESE and other specific procedures.
A targeted study of the male partner allows us to:
- Ascertain a possible male co-responsibility in the infertility of the couple, which is much more frequent than commonly believed
- Conveniently treat cases of severe male infertility according to updated and rigorously scientific criteria, following international guidelines
- Implement all the options offered by Science today to give azoospermic or cryptozoospermic patients the best chances of having their own genetic children, without resorting to a donor by default
- Further investigate any other disorders or diseases of the male genital apparatus, such as erectile dysfunction of various degrees, ejaculation disorders, varicocele, hydrocele, testicular retention, testicular pain, hypogonadism, orchitis, epididymitis, prostatitis and various prostatic diseases, La Peyronie’s disease, phimosis, etc.
Clinical Tests
for Male Partners
Spermiogram
The first recommended test to check male fertility potential is the spermiogram or basic sperm test:
- The evaluation of the total concentration and number of sperm provides information about the integrity of the spermatogenesis process. The detection of leukospermia also indirectly indicates an increased risk of oxidative stress to sperm.
- Similarly, studying morphology and motility (the latter is acquired in the last phase of maturation of the sperm) can provide useful information on the potential ability to procreate naturally.
The spermiogram is interpreted according to quality criteria established by the World Health Organization and reported in a dedicated manual (last update, WHO 2010).
The lower limits of the parameters considered above enabling a couple to conceive a child spontaneously within one year of trying through unprotected intercourse are also shown here.
During the long and complex process of spermatogenesis, male gametes can incur damage to both the DNA and the proteins that give stability to the structure through DNA condensation. These variations negatively influence fertility potential, preventing in the most severe cases fertilization or proper development of the embryo.
Since infertile subjects who have a normal spermiogram exist, further investigation with specific tests or functional tests is recommended.
What functional tests are there?
What is meant by functional test? In our field, the tests needed to evaluate the functional competence of the sperm.
Functional tests give additional information about the “key points” that make the sperm suitable for egg cell fertilization. Since there is no single test that can give this answer, a series of tests is used among the many developed to date.
Chromatin integrity plays an important role in fertilization and supports embryo development.
If more than half of the nucleus is stained blue there is an excess of histones and chromatin decondensation.
During spermiogenesis, the nucleus of the sperm is completely reorganized and becomes highly compact after replacement of the histones with more basic proteins (protamines P1 and P2 according to a precise ratio).
This causes the nucleus of the sperm to acquire a high chemical and mechanical stability that protects it during its journey through the male and female genital tracts and during its interaction with the oocyte.
In addition to clarifying situations of “idiopathic” infertility, functional tests are used to monitor the effectiveness of a medical or surgical therapy more precisely and evaluate the improvement over time.
Andrological
Surgery
Dr. Giovanni Maria Colpi and his team will choose what collection technique to implement, depending on the cause of the absence of sperm in the ejaculate and the patient’s state of health. The andrologist will choose the most suitable technique after carrying out thorough genetic, hormonal, serological, clinical and ultrasound examinations.
The surgically collected sperm can be cryopreserved and used at a later date for ICSI (even for several cycles, if in sufficient quantity), or used fresh, by performing an ICSI on the same day as the partner’s egg collection.
What is it?
TESE stands for Testicular Sperm Extraction: a technique that allows even men with severe fertility problems to become fathers, by recovering sperm from testicular tissue.
What does it entail?
It involves the surgical removal of a small fragment of testicular tissue aimed at collecting male gametes. It may, if necessary, be supplemented by ESE, a similar procedure performed on the head of the epididymis, which sometimes appears to offer a greater quantitative and qualitative sperm collection.
When is it indicated?
It is recommended in cases of:
• Obstructive azoospermia
• Anejaculations
• Other
Prof. Colpi’s School has one of the highest international caseloads of patients suffering from azoospermia. In this field, Prof. Giovanni M. Colpi has, in twenty-two years of microsurgery, increasingly perfected the technique of testicular sperm extraction, particularly indicated in cases of NonObstructive Azoospermia, so-called MicroTESE.
What is it?
MicroTESE stands for Microscopic Testicular Sperm Extraction: it is a technique that allows even men who suffer from severe infertility-related diseases, such as azoospermia, to become fathers, through the microsurgical extraction of sperm.
What does it entail?
It is a microsurgical extraction that allows the extraction of sperm still present in possible small foci of residual spermatogenesis within the testicles.
It allows the surgeon, working at 18-36 magnification via an Operating Microscope, to identify with greater precision the areas of the testicle that, given their specific characteristics (proximity to the vascular network, colour and dilation of the tubules), have a higher probability of containing sperm. In the scientific literature the successful collection of sperm in a higher percentage of patients with NonObstructive Azoospermia thanks to this microsurgical procedure (MicroTESE) (about 60%) compared to conventional techniques (TESE) has been reported.
During the operation, our team always performs a testicular biopsy for histological diagnosis of the state of spermatogenesis. This biopsy is interpreted “blind” by a pathologist extremely experienced in this field and described in a histological report.
During the operation, a biologist assists the microsurgeon in the operating theatre, examining the microfragments of testicular parenchyma just removed in real time to immediately indicate the presence or absence of sperm in them, thus indirectly helping the microsurgeon to identify the optimal areas of parenchyma to draw from.
Biological research then continues in the laboratory in a meticulous and intensive manner for at least four hours after enzymatic treatment aimed at detaching the cells from each other to optimize the quantitative and qualitative recovery of sperm. The comparison between the biological report (i.e. the result of the search for sperm from a small percentage of the removed tissue, performed by the biologist) and the histological report is a very important quality control, generally neglected elsewhere.
In many Centres, experience of cases of NonObstructive Azoospermia is limited, and the risk of a (falsely) negative biological response for the presence of sperm cannot be completely ruled out.
Generally, patients are advised to spend the night after surgery in our clinic in the nursing supervision unit; the operation is preferably performed under general anaesthesia, it is absolutely painless even in the post-operative period and work can be resumed regularly just two days after surgery.
When is it indicated?
It is recommended in cases of:
• NonObstructive azoospermia
• NonObstructive cryptozoospermia
• Other
