Male Fertility Issues
If you and your partner have been trying to conceive for one year without success, there is a chance that the male partner could be the cause or a contributing factor. In about 20% of infertility cases, the sole cause of infertility can be traced to the male partner alone and in an additional 20 to 40% of couples, a contributing factor.
Although there are many reasons for male infertility, a cause cannot be identified in approximately 50% of males tested.
Following a history and physical examination, the initial evaluation of the male partner involves at least one properly performed semen analysis. Ideally, semen should be collected by masturbation, after 2 to 3 days of abstinence, into a clean container provided by the facility and examined within an hour after collection. A 2nd sample is usually recommended in the event of an abnormal initial semen analysis. A comprehensive analysis includes an evaluation of sperm count, overall motility and proportion of normal sperm (morphology) present in the sample. The objective is to get a sense of the semen quality and determine the need for additional testing including hormonal or genetic testing or referral to a specialist in male reproduction/urologist.
Male fertility testing
An abnormal semen analysis is usually an indication for additional testing which may include:
- Blood test to exclude a hormonal problem
- Genetic testing to exclude a chromosomal abnormality
- Urologic evaluation which may include a thorough physical examination, ultrasonography and occasionally testicular biopsy
Specialized Sperm Testing
Although controversial, a variety of specialized tests and procedures are available to measure sperm function and level of DNA damage in the sperm that may adversely affect fertility.
Medical Treatment for Male Infertility
Unless a specific treatable condition is identified in the male, there are no medical treatments that can improve fertility in men with unexplained infertility. Some nutritional supplements have been associated with improved semen parameters but have not been shown to improve pregnancy outcomes.
Surgical Treatment for Male Infertility
Under the care of a urologist, surgical treatment may be a viable option for men with:
- An identifiable reproductive tract obstruction resulting in the absence of ejaculated sperm.
- A varicocele, dilated pelvic veins palpable in the scrotum, resulting in abnormal semen parameters.
Artificial insemination or intrauterine insemination (IUI) has been successfully used for the treatment of male infertility involving mostly low sperm count and low motility. During an intrauterine insemination, sperm is directly deposited into the uterus at the time of a woman’s ovulation.
The likelihood of success with IUI depends on the severity of the male infertility and the presence or absence of other coexisting female infertility factors. Intrauterine insemination can be achieved during a natural menstrual cycle or following ovarian stimulation using oral or injectable medications.
Assisted Reproductive Technologies
In vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) has been used to successfully overcome severe forms of male infertility.
During IVF / ICSI, ejaculated or aspirated sperm are manually injected into eggs that have been harvested from a woman’s ovaries in order to achieve fertilization.
Success with IVF depends on several factors including:
- Maternal age
- Coexisting female infertility factors
- Egg Quality / Ovarian Reserve
- Past reproductive performance
- Other factors including smoking