For many men undergoing fertility treatment, the journey to siring a child begins with identifying what is preventing their ability to make their partners pregnant.

While some couples require medication or intrauterine insemination (IUI), where prepared sperm is directly put into the uterus, others need a more advanced procedure known as Intracytoplasmic Sperm Injection (ICSI).

Both of these procedures require a man to collect his sperm physically or surgically, to give it a better chance of fertilising a woman’s egg.

Unlike normal fertilisation, which relies on thousands of sperm surrounding an egg after intercourse, ICSI requires just one healthy sperm, which is carefully selected and injected directly into the egg.

Read: HSG: Inside the fertility test that many women dread

It is a specialised way of fertilising the egg during in vitro fertilisation (IVF). IVF involves retrieving sperms from a man and mature eggs from a woman’s ovaries, fertilising them in the laboratory and transferring the resulting embryos into the uterus.

ICSI is particularly useful in cases of severe male infertility. The technique adds an extra step to IVF: a single sperm is injected directly into an egg to help achieve fertilisation.

According to urologist Dr Victor Okoth, the technique has transformed treatment for men with severe infertility.

Read: Lab-grown sperm: What a scientific breakthrough means for the millions of infertile men who have run out of options

“The most important advance has been Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected directly into an egg,” says Dr Okoth.

The success of the procedure begins with finding that one viable sperm. While this is often obtained from a semen sample, some men have no sperm in their semen despite producing it in their testes.

A needle in scrotum

In such cases, doctors retrieve sperm directly from the male reproductive tract, using a very fine needle which is inserted into the scrotum or the surgeon makes a small incision in the scrotum. The surgeon may also open the testicle and use a microscope to identify tiny areas of testicular tissue that are more likely to contain sperm.

“Sperm may be obtained from the epididymis or testis through procedures such as Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Microsurgical Epididymal Sperm Aspiration (MESA), or Microdissection Testicular Sperm Extraction (micro-TESE),” Dr Okoth explains.

The approach used depends on the cause of infertility. If sperm production is normal but blocked from reaching the semen, surgery may restore the passage.

Where the blockage cannot be corrected, sperm retrieved from the epididymis or testes can still be used to allow the man to have a child through IVF or ICSI.

“Microsurgical reconstruction may remove the blockage. Surgical sperm retrieval combined with IVF/ICSI is highly successful,” says Dr Okoth.

For men whose testes produce very little or no sperm, the treatment is different. Hormonal therapy may benefit some patients, while a procedure known as microdissection testicular sperm extraction (micro-TESE) can help specialists locate small areas of the testes that are still producing sperm.

If viable sperm are found, they can be used for IVF with ICSI.

Where men are okay

Sperm retrieval for baby-making is not only for infertile men. Men whose partners have blocked fallopian tubes, or when the women are of advanced age and are unable to conceive normally, or if the couples require a more controlled fertilisation process, IVF is recommended.

IVF specialist Dr Rajesh Chaudhary told the Saturday Magazine in a past interview that during the procedure, eggs are collected from the ovaries, sperm are collected, and both are fertilised in the laboratory, and the resulting embryo is transferred into the uterus.

Read: High heels, barefoot driving and infertility: Experts warn of a silent reproductive health crisis

Dr Chaudhary also noted that several factors can influence the success of IVF. Male fertility, however, also plays an important role.

“Success rates vary depending on female age, underlying diagnosis and whether viable sperm can be retrieved, but many couples can now achieve pregnancy despite azoospermia (a condition where there are no sperm in a man’s semen when he ejaculates),” says Dr Okoth.

Advances in assisted reproductive technology have changed what was once considered an impossible diagnosis for many men struggling with infertility.

“The most important message is that a diagnosis of azoospermia is not the end of the journey. Today, many men with azoospermia can still become biological fathers through modern fertility treatments,” says Dr Okoth.

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jngari@ke.nationmedia.com