Diagnosis and Management of male infertility
Infertility in Men
A common misconception is that infertility is only a female problem. In fact, for almost 50% of infertile couples, the cause is related to the male partner (either alone or in addition to a female factor).
When a couple has fertility concerns, Boston IVF recommends that both the male and female partner have full consultations in order to determine the most effective treatment approach.
A common misconception is that infertility is primarily a woman's "problem". In fact, male factor infertility affects the same number of couples as female factor infertility. An additional 25% of couples who seek treatment have more than one factor or condition affecting their ability to reproduce.
To identify male infertility, we analyze a semen sample for the volume of semen, the concentration of sperm, the percent of actively moving sperm and number of normal shaped sperm. Even if one or more of these measurements is lower than normal, a man may have normal fertility. A semen analysis alone cannot fully predict a couple’s fertility. When male infertility is identified, Boston IVF recommends an infertility evaluation of the female.
Some of the causes of male infertility include:
A problem with testicular production of sperm
No sperm (azoospermia)
A blockage or absence of the duct for sperm (vas deferens) from the testicles
A dilated vein in the scrotum (varicocele)
A hormonal imbalance
Lack of sperm mobility or function
Previous injuries or health factors
Ejaculation disorders
Treating Male Infertility If male factor infertility has been diagnosed through a semen analysis, there are several approaches for treatment including drug therapy, surgical therapy, ART, ICSI and donor sperm.
Drug Therapy Hormonal imbalances affecting the development of sperm can usually be successfully treated with drug therapy.
Surgical Therapy When there is a physical barrier preventing sperm production and maturation or ejaculation, a surgical procedure may be the most effective means of retrieving the sperm for insemination. These surgical procedures involve retrieval of the spermatozoa using a thin needle.
ART - Assisted Reproductive Technology The female partner will often undergo intrauterine insemination (IUI) or in vitro fertilization (IVF) to treat certain types of male infertility. In cases where IVF is involved, it is often performed using ICSI. ICSI –
Intracytoplasmic Sperm Injection Intracytoplasmic sperm injection, or ICSI, is used in cases where sperm are insufficient, do not swim properly, or have an abnormal shape that prevents them from penetrating the egg. An embryologist uses a microscope to carefully select, immobilize and draw a single healthy sperm into a pipette. After stabilizing the mature egg of the female partner, the embryologist carefully injects the sperm into the egg. This process takes less than ten minutes and does not damage either the egg or the sperm.
Vasectomy Reversal A vasectomy can often be reversed through surgery. A vasectomy reversal rejoins the vas deferens. It is performed under a light sedation with the aid of a microscope. Pregnancy rates following a vasectomy reversal are generally over 50%.
Infection
One possible cause of male infertility is infection of the prostate, seminal vesicles, urethra, or epididymis. These bacteria may obstruct the transport of sperm or may even attack the testes or epididymis. Although many of these infections may exhibit no symptoms, they can cause permanent scarring and fertility problems. Infections of this nature, are usually treated with antibiotics.
Low Sperm Concentration
Men who are found to have a low sperm count must often undergo a procedure whereby their sperm sample is separated from the seminal fluid and put into a more concentrated form. The concentrated sperm are then artificially inseminated into the woman.
Hormonal Disorders
Sometimes a man may have low levels of hormone production which result in an inability to produce sperm. Although in most instances the cause of this problem is unknown, occasionally, a pituitary tumor may be the cause. The treatment for low sperm production is usually hormonal therapy administered over a period of three to eight months.
Sperm Antibodies
Sperm antibodies in the male may result in impaired sperm motility. These antibodies can interfere with sperm function causing either loss of motility or Sperm Agglutination. Pregnancy may be achieved with sperm washing and intrauterine insemination; IVF may be required.
Surgical Procedures
Sometimes treatments for male infertility may require minor surgical procedures.
Vasectomy Reversal
Surgical reversal of a vasectomy is a procedure which reconnects the ends of the vas deferens so that sperm can once again move from the testicles to the penis. The less time that has lapsed since the vasectomy, the higher the chances of conception. Men who have a reversal within three years of their vasectomy have a greater than 75% chance of conception, between three to eight years it is 53%, after this time chances of conception are approximately 30% to 40%.
Varicocele Treatment
When enlarged veins, known as varioceles, are present in the scrotum they may have an adverse effect on sperm production by increasing testicular heat. Using a minor surgical procedure, these veins can be closed off so that blood flow can be redirected to deeper veins.
Ductal Obstructions
In some men obstructions of the ejaculatory duct have resulted from scarring or infection. This can often be corrected through a simple 30-minute microsurgical procedure.
Ejaculatory Problems
Sometimes a man's sperm instead of being propelled forward through the penis is propelled backward into the bladder during ejaculation. This condition may be the result of medications, surgeries, or nerve damage. If this problem is untreatable, sperm can be recovered from the urine and used for artificial insemination.
