Treatment for Male Infertility

Approximately one in six couples experience difficulty conceiving and for at least a quarter of couples, male infertility is a contributing factor. What is really important to note is that if there is male infertility, in most cases, this can be very effectively addressed.

If you are worried about having (or have been assessed as having) a low sperm count, or even a zero sperm count, this means there is no measurable amount of sperm in your ejaculate. It does not mean you are producing no sperm; rather that your sperm is not being transported outside of your body when you ejaculate.

We have proven, effective methods for retrieving sperm from inside your body (scrotum and testicles), including approaches using specialist microsurgery techniques.

The Birmingham Prostate Clinic specialist in male infertility is consultant urologist Mohammed Belal who is licensed by the Human Fertilisation and Embryology Authority as a male infertility specialist. Through his NHS post at University Hospital Birmingham, he regularly works with gynaecologists at Birmingham Women’s Hospital, providing the expertise in male infertility and microsurgery.

What we offer

We see men who need to be assessed to understand whether they have fertility problems and to diagnose exactly what those issues are. We specialise in microsurgical sperm extraction and often provide this type of specialist surgery working in collaboration with female fertility specialists. We often see men who have had medical treatment and failed biopsies to attempt sperm retrieval. Microsurgery provides a much higher degree of accuracy and success rate in sperm retrieval.

The root cause: obstruction or production?

When there is no sperm present in the ejaculate (called azoospermia), there can be two different causes which can be understood as either obstruction or production problems.

  • Obstructive azoospermia: sperm is being produced in the testicles, but there is a blockage which prevents the sperm from flowing through the reproductive tubes and into the ejaculate
  • Non-obstructive azoospermia: the tubes are open, there is no blockage, but the sperm production is extremely low. This means the tiny proportion of sperm will not make it out of the testicles, so surgery needs to go directly to the testicles to remove sperm

The treatment: TESE or PESA?

If you have been researching treatments or been seen by a male fertility specialist, you are likely to have come across the terms TESE and PESA. Both are designed to retrieve sperm directly from inside the body. TESE stands for microsurgical testicular sperm extraction, which is the approach used for non-obstructive azoospermia. PESA refers to percutaneous epidydimal sperm aspiration and is the preferred method of sperm retrieval for obstructive azoospermia.

About TESE

This is a very effective and minimally invasive procedure for non-obstructive azoospermia, where sperm is found in 70 per cent of cases (and the procedure can be repeated). Under a general anaesthetic, a very small incision is made in the middle of the scrotum to open the testicles. A surgical microscope magnifies the vision 40-fold and the surgeon looks for tubules that are swollen, which is an indication they are likely to contain sperm. The procedure is repeated on the other side of the testicles. The sample is then examined by a laboratory andrology specialist to check for the presence of sperm.

About PESA

This is the preferred method when the cause of the male fertility problem is due to a blockage in the male reproductive tubes, which means sperm cannot pass into the ejaculate. During a PESA procedure, sperm is collected from the epididymis (tightly coiled mass of tubes located inside the scrotum) using a syringe and fine needle. Unlike TESA, there is no need to have a general anaesthetic; local anesthesia is sufficient because the fine needles used make the procedure minimally invasive.

Following both the TESE and the PESA procedures, the next step in the process is Intracytoplasmic sperm injection, often referred to as ICSI. This is a very well established way of addressing male infertility problems. A single sperm is injected directly into an egg, then the fertilised egg is transferred into the woman’s womb.