Infertility is a problem that not only men but also women face today. There are many techniques to solve it. IVF is considered the most popular and effective. Eco efficiency is between thirty and thirty-five percent. Male factor IVF has a number of features. Experts are guided by several methods that can increase sperm activity.

Features of the IVF procedure for men

IVF is not only quite effective method conceive healthy child, but sometimes the only one that can solve the problem male infertility. The procedure is divided into several stages:

1. Ovulation needs to be stimulated. The process is carried out using hormones. In this case, monitoring of the follicles is mandatory.
2. Eggs are obtained by puncturing the follicles.
3. Sperm are obtained in advance and used to fertilize the egg.
4. Obtaining embryos by cultivation.
5. Selecting the healthiest embryos and transferring them into the uterine cavity.
6. After this, the woman must take hormonal drugs to support pregnancy.

Today, two methods of obtaining sperm are used:

• TESE – sperm are obtained from the testicles by extraction.
• MESA is a microsurgery that includes a sperm aspiration factor.

Indications and essence of the MESA method

For male factor infertility, surgery is used to extract sperm from the epididymis. For this purpose, a special liquid is secreted, from which sperm will subsequently be isolated. They are used to fertilize an egg. Indications and results will be successful if the correct extraction procedure is carried out followed by freezing.

The process itself has two methods in its arsenal:

1. The appendages are opened with a small knife. A blunt pipette is used to obtain the liquid.
2. For individual indications, dissection may not be performed. It is replaced by a puncture using a pipette with a small diameter tip.

Indications for using the method are determined individually, after a preliminary examination by a doctor.

Indications and essence of the TESE method

The doctor makes a small incision on the testicles, in a place where there are no blood vessels. After which it is necessary to take from 50 to 700 micrograms of testicular parenchyma. This operation can be performed under general or local anesthesia. It all depends on the individual doctor’s testimony.

Today it is proposed to use more modern methodology, which is called Micro-TESE. It will require all five milligrams of tissue. Even though this is the newest innovative technology, however, does not guarantee receipt more sperm. In this case, there is less damage to the bloodstream, which causes minimal damage to the testicles.

Varicocelectomy method

Quite often, the cause of male infertility is varicocele disease. Its essence lies in the expansion of the veins that are located in the testicles. Blood stagnation occurs in them. If this disease is diagnosed, the doctor determines the indications for varicocelectomy. Correction involves increasing testicular function, which is achieved through the use of normal blood circulation. This process will lead to normalization of spermatogenesis.

Today, this method is often used to treat infertility. In this case, surgery is used that does not cause any harm to the life and health of the man. Surgical intervention is performed in the infrainguinal and groin areas. According to the doctor's indications, the advisability of using general or local anesthesia is determined. In the treatment of infertility, the technique has demonstrated excellent results. All doctors advise using the IVF method only after a thorough examination. With its help, it will be possible to identify the main causes of the disease, as well as apply appropriate treatment.

If sperm has poor performance, then to improve it it is necessary to take the necessary medications. Statistics show that infertility in men is curable in fifteen percent. If you use the IVF method in combination with ICSI, the probability of obtaining a positive result in the form of fertilization of the egg increases to forty percent.

Male infertility should be treated only after the underlying cause has been identified. This can be judged after a full examination and a doctor’s report. He will offer options further treatment, the likelihood of conception, as well as the advisability of using IVF.

The last method is used after all treatment options have been used and there is no positive result. IVF will bring a positive result if the woman and man have previously undergone full course treatment.

Married couples who want, but have not conceived a child after a year of regular sexual relations, think about the possible problem of infertility. The reasons for the absence of pregnancy can be different. To correct the situation, many methods are available, the most effective of which in the fight against infertility is the method of in vitro fertilization (IVF), including IVF for male infertility.

Now this expensive procedure has become available to a wide range of patients due to the fact that it was transferred to the specialized care section and added to the list free procedures, available to holders of a compulsory medical insurance policy.

Restoration of male reproductive function

The proportion of male patients visiting clinics with infertility problems has a disappointing upward trend.

Methods used to treat fertility include:

• Conservative treatment (usually in the form of drug therapy). It turns out good effect at the causes of the problem in hormonal imbalances, infections or inflammatory processes.
• Surgical treatment used for obstruction of the vas deferens.
• Assistive technologies (reproductive) if treatment with the above methods is impossible or ineffective. ART techniques (IVF, ICSI, ISI) are selected after a thorough examination of patients, depending on the cause of infertility, the severity of the disease, and the health status of the patient and his wife.

Methods for obtaining sperm and increasing their quality characteristics:

• TESE method (testicular sperm collection by extraction);
• MESA method (microsurgical sperm aspiration).

Requirements for patients to undergo IVF

The federal program, designed to carry out in vitro fertilization operations free of charge (under compulsory medical insurance), contains a certain set of requirements for patients.

Program participants must:

• be citizens of the Russian Federation;
• be holders of a compulsory medical insurance certificate (policy);
• have medical evidence of infertility (male, female);
• provide evidence of the treatment received, which turned out to be ineffective and did not give the required result;
• confirm the absence of contraindications for the onset of pregnancy due to other factors (except infertility);
• is in suitable reproductive age, limited for women to 39 years.

Both spouses must not have diseases associated with drug addiction, alcoholism or mental disorders. Patients for whom IVF will obviously not be effective and for whom other methods are indicated (donor sperm, surrogacy, donor germ cells).

Couples with a number of bone or bone diseases will receive a refusal. muscular system, gastrointestinal tract, hereditary sexual diseases, abnormal sperm composition (pathological).

Exploratory survey

When a couple contacts a medical institution, the first stage will be an examination of both of them, based on the results of which a conclusion is drawn about the need for a certain method to treat the couple.

If a puncture (of the testicles) is to be performed, additional tests blood (biochemical, coagulogram).

If a male factor is identified in a couple's infertility due to the unsuitability of sperm, an additional ICSI procedure is required, payment for which is not provided for at the expense of the policy.

The operation requires preliminary hormonal stimulation of the woman's follicles and the collection of sperm from the man. If there are spermatogenesis disorders, a man is prescribed special treatment.

Actions to obtain a document to perform an operation under compulsory medical insurance

After visiting the clinic, undergoing the required tests, studies and receiving the results of all examinations, the couple is given a medical opinion on the need for IVF treatment.

The conclusion is studied by the council of the medical institution, which prepares a referral for consideration to the regional commission, which is in charge of selecting applicants to perform the operation using the resources of the compulsory medical insurance fund.

An application is submitted to the regional commission indicating the patient’s consent to the processing of his individual (personal) data and documents, including:

• confirmation of examination results;
• ID card (copy);
• individual compulsory medical insurance policy (copy).

The commission puts the patient on the waiting list - a list for those wishing to undergo the treatment procedure under the policy within the framework of compulsory medical insurance.

In the future, when resources are received from the fund, including the opening of a quota for IVF based on male factor, the client is offered a list of clinics where he can perform the operation. If the list does not indicate the institution where the client wishes to perform IVF, you can submit an application to the commission. A written expression of the desire to receive a referral to this particular clinic must be accompanied by a letter of guarantee from the selected medical institution, confirming its consent to perform IVF surgery within the framework of compulsory medical insurance for a specific patient.

The client has the right to choose the place of treatment at his own request, without taking into account the factor of registration or region of residence.

Having received a referral, the patient goes to the chosen clinic and agrees on all aspects of treatment (beginning, duration) on the spot.

What is paid under compulsory medical insurance?

In the presence of insurance policy Not all procedures that may be needed during IVF surgery for male factor under compulsory medical insurance are paid for at the expense of the fund, with the exception of:

• stimulation of ovulation, taking into account the necessary medicines and medical manipulations;
• punctures (with anesthesia);
• embryo cultivation;
• embryo transfer (into the uterine cavity).

Within the framework of the federal quota, the costs of the operation are covered in the amount of up to 106,000 rubles. Unforeseen expenses that arise during treatment must be reimbursed by patients with their own funds.

In addition to federal quotas, local budgets provide for regional quotas for financing the implementation of in vitro fertilization operations in local clinics using the resources of the compulsory medical insurance policy.

IVF accepts not only citizens who are in a registered marriage, but also cohabiting couples who want to give birth to a baby, as well as single women. In the latter case, payment for the used donor material is made by the patient himself, since it is not included in the list of procedures provided using the resources of the compulsory medical insurance fund.

In vitro fertilization surgery is not only effective, but often the only way to conceive a child when male infertility is diagnosed. The number of IVF attempts for patients is not limited, everything depends only on their physical and psycho-emotional state.

Video on the topic

Male infertility is a common family problem, which must be fought with the strength of both spouses.

Some women begin to experience mixed feelings when communicating with their spouse, but you need to understand that it is also difficult for a man, so he needs to be supported and understood.

After the couple has learned the terrifying diagnosis, the first thing they do is begin to look for solutions - is IVF possible for male factor infertility?

Only specialists can answer this question, but it is known that in medicine there is a solution for infertile men.

When is IVF prescribed for male factor infertility?

The pathology of sperm, which is revealed by the analysis of the material, may already cause the doctor to refer the woman to ICSI.

Receiving sperm is the first step on the path to IVF; if a man is healthy, this step will go unnoticed and quickly, otherwise a specialist will prescribe treatment for him. If naturally It is impossible to obtain sperm; the operation is performed under anesthesia.

IVF is the direct fusion of egg and sperm and their joint cultivation.

Before implanting it into a woman’s body, the embryo is examined for diseases such as cerebral palsy, hemophilia, etc. Also, if the parents wish, the sex of the baby is determined.

Transferring the embryo into the uterus is a simple and painless procedure that takes a few minutes. Several fertilized eggs are introduced into the body; if more than one has taken root, the extra ones are destroyed.

Pregnancy after the procedure occurs in 35% of cases, and childbirth ends in approximately 33%. After 12 days, a pregnancy test is performed.

Childbirth after in vitro fertilization is no different from childbirth after natural conception, just as children born from a test tube are no different from others.

It is believed that IVF is not like that effective procedure, like ICSI, especially in case of male infertility, since in the latter case the specialist independently selects the most viable sperm from the sperm in order to place them in the egg.

A type of ICSI is in which sperm are thoroughly studied and selected.

They dive into hyaluronic acid, as this increases their chances of getting into the egg and developing into an embryo.

Treatment methods for male infertility

IVF for male factor is the simplest method, which almost does not require treatment of the partner, however, many couples, before resorting to artificial insemination trying to get rid of the reasons for the diagnosis.

Drug treatment methods are used for spermatogenesis disorders associated with infections.

The following drugs are used:

1. Adriol, Testoviron, Sustanon-250 – androgens;
2. Menotropin, Pregnil, Profasi are anti-esterogens;
3. Parlodel – inhibitors;
4. Pyrogenal, Taktivin – immunostimulants;
5. Trental – angioprotectors;
6. Solcoseryl, trianol – biogenic;
7. Adriol, Yohimbine, Tentex are drugs for correcting sexual function.

Among the more modern and effective methods treatment IVF, ICSI, .

Conclusion

Male infertility is not a problem for modern medicine, there are many ways to solve this problem. One of the most common is IVF, which gives 35% successful results.

Moreover, experts are confident that neither childbirth nor children born from artificial conception, no different from other kids.

Video: Male infertility – is it necessary to treat before IVF?

The problem of infertility is quite acute today, and not only women, but also men suffer from this. There are numerous methods of treating infertility, but IVF is considered one of the most popular, although its effectiveness is approximately 30-35%. IVF has some special features. Today, experts can offer several techniques specifically for men that help produce and obtain active sperm.

What is in vitro fertilization?

IVF, or in vitro fertilization, today is the main method of treating infertility. Often this is the only method that allows you to conceive a child. He considers one of the most effective this moment even if infertility is observed not in a woman, but in a man. Some experts argue that male infertility can only be treated with IVF.

This method of conception was first used in 1978 in England. Even 200 years ago such attempts were made, although they were not successful. The IVF procedure is as follows: the egg and sperm are combined in a test tube after they have been extracted. The fertilized egg is then placed in the woman's uterus.

Quite often, in vitro fertilization gives an unexpected result; it is possible to conceive twins or even triplets.

This is a completely normal phenomenon, since not one, but several eggs are used for the procedure in order for the effectiveness to be high. If a woman expresses a desire, then the extra embryos are simply removed, but this is very dangerous, since the rest may die or simply be miscarried. early. Doctors do not recommend removal even for triplets. The success rate of IVF is approximately 30-35%, but often it takes more than one attempt to conceive.

When is IVF prescribed? This procedure is very effective if male infertility is observed. It is prescribed for women if available inflammatory diseases, poor maneuverability fallopian tubes. For men, this is poor sperm quality, a low number of active sperm, previous genital surgeries, and previous inflammatory diseases. But in some cases, IVF can not be carried out, but simply introduce sperm into the uterine cavity with controlled conditions. Although obtaining sperm is quite difficult, IVF is much easier and faster, and there is a greater chance of success.

The IVF method itself is not used as often as it would be possible. The problem is that the method is expensive, and it is not available to everyone who needs it. The state does not provide subsidies for IVF centers; they cannot even be found in all major cities.

If a couple contacts the center, it is necessary to undergo a preliminary examination, which will show what the cause of infertility is. For a man, a spermogram is mandatory, and genetic studies are carried out. This usually takes 2 weeks, after which the doctor decides which method can be used to conceive.

IVF methods for men

IVF methods are quite effective, and often the only ones that can help if male infertility is diagnosed. There are several stages of fertilization, the general procedure includes:

1. Stimulation of ovulation using hormones, subsequent monitoring of follicles.
2. Puncture of follicles to obtain eggs.
3. Fertilization using previously obtained sperm.
4. Embryo cultivation.
5. Transfer of all selected embryos into the uterine cavity.
6. The woman is prescribed hormonal support.

To obtain sperm and improve their quality, 2 are additionally used various techniques prescribed by the doctor:

1. Performing sperm extraction from the testicle - the TESE method.
2. Prescription of microsurgery for the purpose of sperm aspiration - MESA method.

What is the essence of the MESA method?

This method involves performing a microsurgical operation to obtain sperm from the epididymis. A special liquid is taken, from which sperm are isolated, intended to fertilize the woman's egg.

Only a few cubic milliliters of special epididymal fluid provide a real opportunity to isolate sperm that are suitable for successful fertilization of the egg. Therefore, specialists subject a certain part of the obtained material to cryopreservation, freezing, which makes it possible to immediately preserve sperm for subsequent attempts.

This procedure is carried out using 2 methods:

1. The appendage is opened with a microknife, after which the liquid is taken with a blunt pipette.
2. No dissection is performed, only puncture of the appendages and spermatic cords is performed using a micropuncture pipette, the tip of which has a diameter of only 0.25-0.35 mm.

The choice of method is determined by the doctor only after the examination. The procedures themselves are absolutely safe, they are performed in the shortest possible time.

How is TESE performed?

The manipulation is performed on the testicles; the doctor selects an area where there are no vessels on the surface, and then makes an incision. Approximately 500-700 mg of testicular parenchyma is excised. The microsurgical operation itself is performed under general or local anesthesia, it all depends on the doctor’s prescription.

Today there is an improved sperm extraction technique - Micro-TESE. A much smaller portion is removed, only 3-5 mg of tissue. But the technology for obtaining sperm is more advanced, which means that the number of sperm will be higher. During the procedure, the entire blood network is identified, and this reduces the risk of testicular damage to a minimum.

Varicocelectomy for infertility

In some cases, the cause of infertility in men is varicocele disease. This is an enlargement of the veins in the testicles, it occurs due to blood stagnation. If a man is diagnosed with this disease during examination, and along with it the sperm parameters are pathological, and conception does not occur for a long time, then the doctor prescribes a varicocelectomy method. It is based on the fact that the observed disease causes a decrease in testicular function, and correction will help not only restore normal blood circulation, but also ensure good spermatogenesis.

Today this method of treatment is common. Surgery is used, but it is very subtle and does not cause harm general health. This is microsurgery of the infrainguinal and inguinal approaches. The procedure is performed under local or general anesthesia, depending on the doctor’s indications. For infertility, this treatment provides enough good results. That is why, before IVF, experts advise conducting a full examination, which will show the need for surgical intervention.

If sperm counts are poor, an improvement in sperm quality is usually prescribed. At the same time, infertility in men can be cured in approximately 5-15% of all cases. If IVF is combined with ICSI, the effectiveness increases significantly, it is 20-40%.

The choice of method for male infertility depends on what diseases are observed. The doctor conducts a preliminary examination of the man, after which he makes a conclusion about the possibility of conception and treatment options. Typically, IVF is offered after all the underlying causes of infertility have been eliminated, but the woman does not achieve the desired pregnancy. Of course, the examination is carried out on both partners, but when the woman is healthy and the man has completed the necessary course of treatment, IVF, or in vitro fertilization, usually brings a positive result.

How many times can IVF be performed?

With male factor infertility, this condition can usually be overcome only in 30-35%. Artificial insemination is not always successful, which the doctor must warn about before starting the procedure. Usually, out of 100 couples who apply, only 30 get results and the woman manages to conceive a baby. But what about the remaining 70? It is recommended to make more attempts after unsuccessful first You can't ever despair.

How many times can IVF be repeated? The issue must be resolved strictly individually; only a doctor will be able to determine what amount is acceptable for each specific case. IVF is completely safe method, but you can’t constantly make attempts, this can greatly affect the psyche, since failures and constant unjustified hopes can cause stress. In some cases, IVF brings a positive result only on the 8th or even 10th attempt. There is also a reasonable limit; for repeated attempts, those embryos that were not used in previous times are usually used.

IVF is an artificial insemination procedure when it is not possible to conceive a baby in the usual, natural way. Various techniques are used, it all depends on what kind of infertility needs to be treated. For example, procedures for men are different from women's. IVF is not always successful; in this case, the doctor may recommend donation or surrogacy.

Male factor infertility: causes, diagnosis and treatment of male infertility using IVF, ICSI, AI methods

It is generally accepted in the world that only from 7 to 17% married couples- barren. has a steady upward trend. If we consider infertile couples, then in 50% of cases of absence of pregnancy, men are responsible (of which 25% is isolated male infertility and 25% is combined: male and female).

Conclusions from the analysis of spermogenic function in men are real proof deterioration of spermogram parameters. The method of treatment - drug therapy, elimination of the causes of decreased fertility, IVF - is selected based on the medical history, diagnosis of the severity of the condition and examination results.

• Diagnosis of male factor infertility
• Who treats male infertility
• Treatment of male infertility
• Artificial intrauterine insemination
• IVF for male factor infertility
• IVF ICSI
• IVF PIXIE
• Severe male factor infertility

Factors influencing decreased male fertility

It has been scientifically proven that to identify factors of male infertility The following reasons play a role:

• Temperature: 2 hours of sitting causes an increase in scrotal temperature of 2 °C - “taxi driver syndrome”. This is a very harmful phenomenon that adversely affects the quality of spermatogenesis. The temperature in the scrotum is always lower than in the rest of the body - this is necessary condition for the maturation of full-fledged sperm. Under the influence of external or internal temperature factors (for example, hyperthermia during ARVI), a change in the morphological structure or mobility of germ cells occurs.

• Alcohol: high risk is fact . This is 4-5 drinks once or 15 or more drinks per week (1 drink = 14 grams ethyl alcohol). The effect of alcohol leads to a decrease in the quality and quantity of germ cells in a man.
• Smoking: an extremely unfavorable factor influencing the DNA of male germ cells and, as a consequence, the DNA of the developing embryo if conception occurs. Nicotine promotes the gluing of gametes.
• Chemo- and radiotherapy: germ cells develop from stem cells, under the influence of these physical factors sperm precursors die or lose the ability to develop into more mature forms.

Prognosis for male infertility

The outcome of treatment for male factor infertility is influenced by prognostic factors:

• Duration of infertility.
• Primary or secondary episode of infertility (was there any earlier pregnancy from this man).

Main causes of male infertility

1. Testicular insufficiency: caused by hormonal disorders, previous illnesses, injuries, congenital diseases.
2. Endocrine factor of male infertility. This includes diseases accompanied by a disruption in the production of not only sex hormones and pituitary hormones, but also diabetes, diseases thyroid gland, pituitary adenoma, obesity. Endocrine disorders account for 25-35% of all male infertility.
3. Obstruction of the male reproductive tract. There is an obstacle to ejaculation caused by genetic (eg cystic fibrosis), infectious and inflammatory diseases.
4. . Their appearance can be characterized as the appearance of an allergic reaction of the body to its own sperm. These antibodies disrupt, first of all, the motility of gametes.
5. Drug therapy (especially antibiotics), stress, chemical substances(even household chemicals), environment. The spermatogenesis cycle (the appearance of a mature sperm with the ability to fertilize) lasts 72-75 days. If during this time the influence of drugs or chemicals occurs, the morphological structure of the cell is disrupted - a sperm with an abnormal structure develops.
6. Stress leads to disruption of the production of male sex hormones, which affect the maturation of germ cells in men.
7. Varicocele is an enlargement of the veins in the scrotum.
8. Sexual disorders – ejaculation disorders due to neurological disorders (spinal hernia) and hormonal disorders. Retrograde ejaculation is when ejaculate enters the bladder.
9. Genetic diseases with chromosomal abnormalities.
10. Idiopathic infertility is infertility for which obvious reasons were not found. Vitamin deficiency falls into this category.

Examination for male factor infertility

Who treats male infertility

If pregnancy does not occur within 6 months while maintaining an active and regular sex life or changes are detected in sperm tests, it makes sense to contact an andrologist for an initial consultation. The doctor will prescribe additional examination methods and treatment. An andrologist is the first clinical specialist who has the ability to treat certain male pathologies reproductive system. In some cases, these recommendations for lifestyle correction and therapeutic treatment solve the problem of male factor infertility.

If the problem is not solved at the clinical stage or treatment is not possible, it makes sense to resort to artificial insemination using IVF or other assisted reproductive technologies (ART).

Treatment of male infertility

Depending on the potential of a man’s reproductive cells, reproductive medicine clinics can offer the following types of treatment using ART:

1. - V Lately Doctors began to be skeptical about the method.

Artificial intrauterine insemination for male factor infertility

Effectiveness largely depends on the patient's medical history. It is enough to have motile sperm with the correct structure in the ejaculate. A prerequisite is:

• negative MAR test (absence of immunological infertility);

Like every method of assisted reproductive technology, it has its own disadvantages and advantages.

The ejaculate itself consists of 2 fractions - sperm and seminal plasma. To carry out IVF, seminal plasma is separated and only living cells that have an intact membrane are taken further for work. Depending on the characteristics and volume of gametes obtained, anamnesis data and additional research methods, the fertilization method is selected.

Adding sperm to an egg in a culture medium is standard IVF. The choice of sperm occurs by the egg itself on the basis of evolutionarily formed, not fully known markers.

ICSI

At sharp decline sperm parameters, they resort to micromanipulation techniques - ICSI - intracytoplasmic sperm injection. The choice of sperm is made by the embryologist based on morphological criteria and personal experience.