Don't give up on the family you dream of: increase your chances of becoming a father.
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.
The Clinical Andrology Service of Next Fertility Procrea is directed by Dr. Giovanni M. Colpi, Scientific Director of Procrea, and is dedicated to treating the male partner of infertile couples.
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.
The first recommended test to check male fertility potential is a semen analysis or basic semen test. The semen analysis is performed according to quality criteria established by the World Health Organisation and reported in a dedicated manual (last update, WHO 2010).
The lower limits of the parameters examined above are also indicated here, which allow a couple to conceive a child spontaneously within a year through unprotected intercourse.
The evaluation of sperm concentration and total sperm count provides information on the integrity of the spermatogenesis process. The detection of leukospermia indirectly indicates an increased risk of oxidative stress for spermatozoa.
Similarly, the study of morphology and motility (the latter is acquired in the final stage of sperm maturation) can provide useful information on the potential ability to procreate naturally.
Since there are infertile individuals who have a normal semen analysis, further investigation with specific or functional tests is recommended.
Functional tests provide additional information on the ‘key points’ that make sperm suitable for fertilising the egg cell. Since there is no single test that can provide this answer, a series of tests are used from among the many that have been developed to date.
This test assesses whether the sperm is viable and has membrane integrity, which is the first requirement to carry out all its functions.
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.
Dr. Giovanni Maria Colpi and his team will choose the recovery technique to be used based on the factor causing the absence of sperm in the ejaculate and the patient’s state of health. Sperm recovered surgically can be cryopreserved and used later for ICSI (even for multiple cycles, if the quantity allows), or used fresh, performing ICSI on the same day as the partner’s egg retrieval.
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.
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.
It is recommended in cases of:
• Obstructive azoospermia
• Anejaculations
• Other
What is it?
MicroTESE stands for Microscopic Testicular Sperm Extraction: it is a technique that enables even men affected by severe infertility-related conditions, such as azoospermia, to become fathers through the microsurgical retrieval of spermatozoa.
What does it involve?
It is a microsurgical extraction procedure that allows for the retrieval of spermatozoa still present in small residual foci of spermatogenesis within the testicles.
This technique enables the surgeon—working at 18–36x magnification using an operating microscope—to more precisely identify the areas of the testicle that, due to certain specific features (proximity to the vascular network, color, and tubule dilation), have a higher likelihood of containing sperm. Scientific literature reports a higher rate of successful sperm retrieval in patients with Non-Obstructive Azoospermia (NOA) using this microsurgical procedure (MicroTESE) — approximately 60% — compared to conventional techniques (TESE).
During the procedure, our team also routinely performs a testicular biopsy for histological diagnosis of the state of spermatogenesis. The biopsy is reviewed “blind” by a highly experienced pathologist and described in a detailed histological report. A biologist is also present in the operating room during the procedure, assisting the microsurgeon by examining in real time the microfragments of testicular tissue that are removed, immediately indicating whether sperm are present. This real-time feedback helps guide the surgeon in identifying the optimal areas of testicular parenchyma to sample.
The biological search then continues meticulously and intensively in the laboratory for at least four hours. The tissue undergoes enzymatic treatment to separate all the cells from one another, thereby optimizing both the quantity and quality of sperm retrieval. The comparison between the biological report (i.e. the result of sperm search from a small sample of the extracted tissue, performed by the biologist) and the histological report represents a crucial quality control step—one that is often overlooked elsewhere.
The “fresh” approach involves performing the sperm retrieval simultaneously with the female partner’s oocyte pick-up, so that the spermatozoa can be used immediately for ICSI. This avoids both the numerical loss of sperm and the DNA damage that can result from cryopreservation.
Of course, any excess spermatozoa retrieved are prudently cryopreserved. However, since the fresh procedure often leads to the desired pregnancy, the need to use these previously frozen spermatozoa is generally rare.
How to avoid inappropriate treatments
(which in some cases may even amount to real malpractice).
Prepared by Prof. Giovanni M. Colpi.
