Male infertility is a very common cause of
infertility being present
in up to half of all infertile couples. The male fertility evaluation, the semen analysis,
is one of the most important fertility
tests and must be performed early in the infertility
workup, before any therapy of the female begins.
Sperm are evaluated using several different criteria with normal values defined by either the Kruger Strict Criteria or the World Health Organization. Most reproductive laboratories and fertility specialists use the Kruger Strict Criteria and normal values are as follows:
- Count or Number of live sperm (Normal = > 20 million per milliliter)
- Viscosity (Normal = None or slight)
- Volume of fluid in the ejaculate (Normal = 2-5 milliliters or cc)
- Motility or ability to move or swim in a straight line (Normal = > 50%)
- Shape and size of the sperm (Normal = >14% “highly normal forms”)
- pH (Normal = 7.5 – 9.0)
Some other male infertility tests we occasionally employ
when there is a known male factor are the "Sperm DNA
Decondensation Test" (which measures the integrity of
the sperm’s DNA) and the "Y Chromosome Microdeletion
Test" (which tests for a genetic cause of infertility).
These male infertility tests may be offered after the initial semen
analysis is performed.
Sperm take three months to develop, so semen analysis values measured today are a reflection of the “sperm environment” three months ago. Sperm are initially formed in the testicles and travel through the epididymis, the vas deferens, and ultimately are ejaculated out the penis.
Sperm are very sensitive to temperate and must be maintained slightly above body temperature. The scrotum is the body’s way of heating and cooling sperm. When the sperm temperature is too high, the scrotum expands moving the testicles farther away from the body. If the temperature is too low, the scrotum contracts and brings the testicle closer to the body.
Environmental factors, or other conditions, that cause prolonged increases in sperm temperature can cause varying degrees of male infertility. Examples include prolonged, regular, sitting in hot tubs, occupations that interfere with the scrotum, such as long distance truck drivers, etc. Exposure to certain heavy metals and other environmental agents has been associated with male infertility.
Sometimes a varicocele will form. A varicocele is a collection of varicose veins in the spermatic cord, which slows blood flow and thus increases testicular temperature thus resulting in male infertility. A urologic surgeon can often surgically treat varicoceles.
Male infertility can occur when a man forms
antibodies
to his own sperm, although antisperm antibodies are
relatively rare unless the man has undergone a vasectomy
reversal. In order for male antisperm antibodies to
form, there must have been exposure of semen to blood
as caused by trauma or surgery.
Male Infertility- Treatments
Male infertility can sometimes be treated surgically. Surgery
is an effective treatment for varicoceles, some cases
of blocked tubes, vasectomy reversal, and other conditions.
There are very few medical (drug) treatments for male
infertility. Few fertility drugs have been conclusively shown to
appreciably increase sperm count or improve sperm quality. Long
term Clomid use
has caused small improvements in male infertility but it must be emphasized
that sperm quality today is a reflection of three months
ago.
Male infertility can have hormonal causes such as hypogonadotropic
gonadism which is a state of severely low levels of FSH and LH. FSH (Gonal-F, Follistim, Bravelle, Menopur, Repronex)
is effective in treating this condition;
however, hypogonadotropic
gonadism is rare and treatment requires
at least three months and is extremely expensive.
Sometimes men have changes in their “life
situations” causing them to seek a vasectomy reversal.
A skilled surgeon can sometimes reverse a vasectomy. Even so, men considering a vasectomy must understand that it is intended to be a permanent means of birth control. Whether or not the tubes can be
reconnected, depends upon the amount of scarring, where
the tubes were cut, how much of the tubes remain, and
how much time has elapsed since the vasectomy. IVF
usually produces superior success rates, especially
if much time has passed since the original vasectomy.
Male Infertility- IVF with ICSI
Most couples with male infertility opt for intracytoplasmic
sperm injection (ICSI) with IVF.
In ICSI, a single sperm is injected directly into the
egg. If there are no sperm in the ejaculate, they can
often be retrieved directly from the testicles or reproductive
tract. ICSI causes fertilization in the majority of
male infertility patients.
When male infertility is treated, success, in terms of a baby, is a function of the programs IVF success rates, the couple’s history, and other causes of their infertility that might be present. The good news is that the IVF pregnancy rate from ICSI tends to be as good as the IVF pregnancy rate with normal sperm.
Other options for severe male infertility includes the use of donor sperm in an IUI or IVF cycle or adoption. While donor sperm is much easier and less expensive than ICSI, it can produce a lot of anxiety in the couple because of the various psychological issues. For this reason, we highly recommend counseling for these couples to work out the issues before they get pregnant. Adoption is also a good option and can be easily arranged locally. If either of these options appeals to you, please consult our fertility clinic staff.
Finally, male infertility can be
very stressful due to the many options, the wide range
of costs, and the multiple psychological issues.
We believe strongly in a team approach and encourage
you to seek input from not only our fertility clinic staff but also counselors
or adoption professionals. We believe in working
with local urologists so if you are diagnosed with
male infertility we will arrange a consult with a urologist.
Please feel free to ask us any question that is on your
mind.
