Male Infertility
Only one sperm is enough to achieve fatherhood & hear a gurgle!
How to go About?
- Physical Evaluation
- Problem Identification
- Investigation
- Diagnosis
(Are there enough, healthy motile sperms?)
If not ask your doctor for advice.
What is IVF-ICSI?
IVF is the acronym for In-Vitro Fertilization (fertilization done outside the womb). Intra Cytoplasmic Sperm Injection (ICSI) is a laboratory procedure done in conjunction with IVF. ICSI involves injecting a single sperm into an egg in a petri dish. Because the sperms do not have to swim towards the egg, this procedure can succeed even with extremely immature sperm.
How common a problem is male factor Infertility?
In 60% of all couples experiencing infertility, a male factor is involved. It is primarily a male factor in 40% of these couples and in an additional 20% of these couples, it is a combination of male and female factors. Therefore, when a couple is having trouble conceiving it makes sense not only to evaluate the woman but to evaluate the man as well.
What causes Infertility in men?
Infertility in men is most often caused by:
- problems making sperm -- producing too few sperm or none at all
- problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
What increases a man's risk of Infertility?
The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:
- alcohol
- drugs
- environmental toxins, including pesticides and lead
- smoking cigarettes
- health problems
- medicines
- radiation treatment and chemotherapy for cancer
- age
How do you test for male Infertility?
The general purpose of a man’s evaluation (semen analysis and, if appropriate, a consultation) is to identify any problems and address them in order to maximize the quality of the man’s semen. This may reduce the need for more complicated interventions for the female partner. It is also important to rule out significant medical problems that may contribute to a poor semen analysis. Therefore, the most important first step in any man’s evaluation is the semen analysis.
What is a semen analysis and will it tell me if I am fertile?
Semen is the fluid that a man ejaculates. This fluid is produced at several different sites. The sperm within the semen are the cells that actually fertilize the egg and are therefore the most important to assess. However, the sperm account for only 1-2 % of the semen volume. Problems with the surrounding fluid may also interfere with the movement and function of the sperm. Therefore, both the sperm and the fluid must be tested.
What tests are included in a basic semen analysis?
- Concentration (sometimes referred to as the "count")
This is a measurement of how many million sperm there are in each milliliter of fluid. Counts of less than 20 million per milliliter (<20 million/cc) are considered sub-fertile.
- Motility (sometimes referred to as the "mobility")
This describes the percentage of sperm which are moving. 50% or more of the sperm should be moving.
- Morphology
This describes the shape of the sperm. The sperm are examined under a microscope and must meet specific sets of criteria for several sperm characteristics in order to be considered normal. Most commercial laboratories will report WHO morphology (i.e. use World Health Organization criterion). 30% of the sperm should be normal by these criteria.
- Volume
- Total Motile Count
This is the number of moving sperm in the entire ejaculate. in the ejaculate.
- Standard Semen Fluid Tests
Color, viscosity (how thick the semen is) and the time until the specimen liquefies should also be measured.
What are the treatment options when there is a poor semen analysis?
Over 50% of men will have a treatable cause of male factor infertility. These factors include varicoceles (dilated veins in the scrotum) infections, hormonal abnormalities, abnormalities in the seminal fluid, ductal blockages, and difficulties with erections and ejaculation. When these conditions are treated, either through medication (hormones, antibiotics), or surgery (varicocelectomy, vasal reconstruction, repair of a blocked ejaculatory duct) a man will often see a significant improvement in his semen analysis.
Men with idiopathic or unexplained infertility can make lifestyle changes that may result in improvement in his semen analysis. Even men with poor semen analyses whose conditions are not treatable or unexplained may still have the option of using advanced reproductive techniques to achieve a pregnancy. Even those men with no sperm in the ejaculate may be able to have some living sperm procured from them through other methods and achieve a pregnancy using advanced reproductive techniques. Those few men, who produce absolutely no sperm at all, will have this information so that they can explore other options.
Treating Male Factor
Varicocele: The options are either surgery to close it off, or balloon insertion to block the blood flow.
ICSI: Done in conjunction with IVF. After the eggs are retrieved, a single sperm is injected into each mature egg. Stats on ICSI vary _widely_ from clinic to clinic. It is a good idea to check out the clinic and the embryologist for their ICSI statistics before doing ICSI. A fertilization rate of at least 50-60% should be expected with a good clinic and currently the better clinics have a 35-45% ongoing pregnancy rate. (needle aspiration of sperm, inject in egg, implant egg again, supposed to work even with quite low sperm counts).
What lifestyle changes can be made to improve the quantity and quality of sperm?
- Quit Smoking
- Stop Taking Recreational Drugs
- Marijuana (cannabinoid)
- Cocaine,
- Anabolic Steroids (male hormones) use has reached almost epidemic proportions. 6.6% of 12th grade males use or have used them to build muscle mass and improve athletic performance. These male hormones suppress the testes ability to make testosterone. This decreases the intratesticular testosterone level. Anabolic steroids also depress testicular production of testosterone and, thus, levels of testosterone inside the testes itself. This may cause severely diminished spermatogenesis or complete absence of sperm (azoospermia). When taken, these steroids cause a persistent depression of the hypothalamus and pituitary that may be irreversible, even when the steroids are stopped.
- Reduce Alcohol
- Avoid Lubricants
Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle.
- Exercise
- Avoid High Temperatures
- Take Vitamins (antioxidants)