With Dr. Abayomi Ajayi

The “better” the semen quality, the higher will be the chances of a spontaneous pregnancy over time but as yet, there is no accurate method of assessing the chance of a pregnancy by time for a particular couple.

Time “trying” is the best predictor but now this is often not useful since most couples see their doctor early on in their

Treatment of varicoceles, low-grade infections, stress or heat exposure, generally has no dramatic or continuing beneficial effect. Reconstructive surgery for epididymal obstruction should always be considered as it can offer up to a 30 per cent chance of a pregnancy and of course can be curative. There is a clear-cut correlation between the chance of a pregnancy and the length of time since a vasectomy – the shorter the interval the better the outcome.

If the interval is less than three years one can expect 70 per cent of couples to achieve a pregnancy whereas if over 14 years then only 30 percent will have success.

The simplest “high tech” treatment for male infertility is artificial insemination of prepared sperm in conjunction with mild ovarian stimulation of the woman.

When more than one million motile sperm can be retrieved after a sperm wash, it is associated with up to a 10 per cent chance of a pregnancy per cycle. Most pregnancies occur within the first three cycles.

Pregnancy rates depend on the number of sperm inseminated and the number of follicles stimulated.

Unfortunately, for most couples with male-based infertility, sperm quality is too poor to consider this option. Those who wish to have treatment have to decide between the high-tech, high-cost option of IVF/ICSI or the low-tech, low-cost option of donor insemination.

Before the advent of ICSI, the difficulty with IVF was trying to predict whether or not fertilisation would occur. Now ICSI gives rise to the same fertilisation rate as conventional IVF and if there is any doubt as to sperm quality, we advise ICSI.

Most men with azoospermia often have some sperm in the epididymis or testis that can be retrieved for ICSI. The difficulty is trying to predict in which men with “non-obstructive azoospermia” sperm can be retrieved.

This term refers to men who may have sperm production in the testes but the number produced is too few for them to appear in the ejaculate.

At least some and perhaps half of male infertility have a genetic basis, and male children may inherit their fathers’ infertility.

The chance of pregnancy per embryo is at least as high with ICSI as with conventional IVF. The cumulative chance of a live birth following four cycles of IVF is up to 70 per cent but few couples are able to undergo this number of treatments because of the cost, either emotional or financial.

Therefore, many couples will still choose donor insemination, either in preference to IVF or following one or two failed cycles of IVF.

Provided the couple is comfortable with the use of a donor, this option can be most successful with up to an 80 per cent chance of a family.

Although assisted reproductive technology will help many infertile men have children, it does not treat their condition.

Indeed, there is very strong evidence that the majority of male infertility is genetically based, so that for the foreseeable future we will continue to make better use of the sperm that there are, rather than improving their number or quality.