The time has now come to take male fertility seriously. The physical and psychological effects of male fertility (often 50% of the problem) can no longer be ignored. Fertility units, specialising in IVF and ICSI, have done a great service to thousands of couples who would otherwise have remained childless, but we must go further, by trying to ensure that we create the optimum environment for sperm production, and then to assess the quality of the sperm, before it is used for treatment.
“We should treat the man, and not just the sperm” says Jonathan Ramsay, who has been a Consultant Urologist in London for 30-years, where he has responsibility for the Andrology Department at Hammersmith Hospital, which is the Male Fertility Research Centre for Imperial College Healthcare.
For the past 10-years, Jonathan has concentrated on all aspects of male fertility, both diagnostic and surgical. Research interests have included the introduction of a range of diagnostic tests to understand “unexplained infertility” and to diagnose the cause of male infertility, so often ignored by fertility units, which tend to be run exclusively by gynaecologists.
With close collaboration with endocrinologists, nutritionists, and with laboratory-based scientists, the aim is to improve the quality of the sperm, to increase the chances of a natural, or assisted, conception.
Current research interests are concentrating on the roles of nutrition, weight-loss, and genital tract infection on overall fertility.
The approach to non-obstructive azoospermia, in which micro-testicular dissection remains the principal treatment modality, has been enhanced by the use of testicular mapping, and pre-operative hormonal manipulation. Currently, we are developing techniques to assess the quality of sperm retrieved from the testis, prior to assisted conception.
Jonathan therefore takes a holistic approach to managing both individual men, and couples, both before and after they have undergone fertility treatments. We would hope to be able to maximise the chances of success of IVF and ICSI, but we would also hope to be able to improve male fertility, such that some couples might achieve natural conception, without the need for intervention.
When there is an absence of sperm, particularly when this is due to non-obstructive causes (non-obstructive azoospermia) we look to improve the chances of sperm retrieval by hormonal treatments, where appropriate, and sometimes by undertaking a diagnostic mapping procedure, before we plan a micro-testicular dissection (M-TESE).
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