Severe Male factor infertility includes severe oligospermia, oligoasthenoteratozoospermia(OATS) and Azoospermia. These patients are seen either by a surgeon or an urologist and treated as per the cause. For example if the patient has an infection ,he is given antibiotic course.If he has a palpable varicocele,it is surgically corrected.In cases of Hypogonadotropic hypogonadism gonadotrophins are given.After successful completion of treatment sperms are obtained and frozen for future use with ICSI.
If no cause is found patients can be empirically given Clomiphene, Carnitine,Coenzyme Q or Gonadotrophins.
If after treatment sperm count improves to 5-10million/ml ,2 cycles IUI can be tried followed by ICSI.If count is still less than 5 million/ml one can directly go for ICSI.If there are <4% normal forms then PICSI or IMSI is the method of choice.
The advanced technique of Microfluidics can be used in these cases.
In cases where Sperm DNA fragmentation is >30% it is suitable to give antioxidants or treat varicocele if present.If there is no improvement then TESE ICSI needs to be done.
With the availability of the advanced technique of spindle check in our centre the eggs can be injected only after the appearance of spindle using inverted microscope and thereby preventing injury to the spindle as well.
Our unit started ICSI in 1995 and were the fourth centre in India to start it.Our’s is also the first unit to install IMSI and Spindle check.Many of our units also have the advanced technology of PICSI.