Many people may be surprised to learn that 40% of infertility in couples is actually due to male infertility.
The Semen analysis is one of the first diagnostic steps in the evaluation of the male partner. If this suggests abnormalities in the semen, then further investigation into why the semen is abnormal is undertaken.
Medical Treatments to Improve Male Factor Infertility
Vitamins may be prescribed for vitamin deficiencies.
Hormones may be prescribed if there is suggestion of an endocrine disorder:
Clomiphene citrate, Letrozole, HCG and HMG treatments which are medicines frequently utilized as fertility medicines for females can also be used for the male. In addition, bromocriptine may be prescribed for pituitary prolactinomas. IF indicated, medicines to treat the thyroid or diabetes/prediabetes or high cholesterol may be utilized.
Changes in diet may be suggested: it is highly recommended that a whole foods, plant based diet which incorporates many fruits and vegetables is followed closely. Avoidance of fast foods and highly processed foods is critical.
- Weight loss may be recommended.
- Exercise is always recommended.
- Herbal supplements may be suggested.
- Some medicines may hinder sperm and these medicines need to be avoided: medicines such as calcium channel blockers , testosterone steroid hormones, allopurinol for gout are some that should be changed.
- Avoidance of ingestion of alcohol, tobacco and marijuana as well as other illicit substances.
- Medicines, like Viagra and Cialis, may help men with ejaculatory dysfunction.
Intrauterine insemination is a procedure whereby sperm is collected via ejaculation, the sperm is processed in the lab ( sperm is separated from semen) and then a small volume of sperm is resuspended in special liquid and transferred into the women’s uterus. This is well timed to the woman’s ovulation.
This improves pregnancy rates per month in couples with certain causes of infertility. It is recommended that this treatment be utilized if there are at least 5 million motile ( moving) sperm. If the total motile sperm count is less than this, IVF w ICSI (see below) may be a better treatment alternative.
Who can benefit from IUI?
- Single women or lesbian women
- Couples with unexplained infertility
- Couples with only MILD male factor infertility ( total motile sperm in the processed IUI specimen of 5 Million)
- Couples who have difficulty with copulation
- Couples who have decided to use TRADITIONAL surrogacy to grow their family
- Couples whose male partner is not available frequently to do fertility treatments
- Men who stored their sperm before cancer chemotherapy
IVF (In-vitro Fertilization ) with ICSI (Intracytoplasmic Sperm Injection)
ICSI or intracytoplasmic sperm injection can only be done during an IVF/in vitro cycle. The use of ICSI provides an effective treatment for male factor infertility. ICSI involves the direct injection of a single sperm into the interior of an egg using an extremely thin glass needle. The negative effects of abnormal semen characteristics and sperm quality on fertilization can be overcome with ICSI if live sperm are available because the technique bypasses the shell around the egg to deliver the sperm directly into the egg. ICSI allows couples with male factor infertility to achieve fertilization and live birth rates similar to those achieved with in vitro fertilization (IVF) using conventional methods of fertilization in men with normal sperm counts. ICSI can be performed even in men with no sperm in the ejaculate if sperm can be successfully collected from the epididymis or the testis.
Who can benefit from ICSI?
- Men with low sperm counts
- Men with low motility of sperm
- Men with many abnormally shaped sperm
- Men with no sperm in the ejaculate (but sperm in the testicle)
- Men with a prior vasectomy
- Men who are paralyzed and cannot ejaculate
- Presence of antisperm antibodies
- Couples who have had failed fertilization on a prior IVF cycle
- Men who have limited frozen sperm in the freezer stored before cancer chemotherapy
Are there risks with IVF and ICSI?
ICSI may be associated with a slightly higher risk of birth defects. Whether this association is due to the ICSI procedure itself or to inherent sperm defects has not been determined. The impact of ICSI on the intellectual and motor development of children has also been controversial, but recent studies have not detected any differences in the development of children born after ICSI, conventional IVF, or natural conception.
Certain genetic abnormalities have been shown to increase in IVF offspring. The prevalence of sex chromosome (X and Y) abnormalities in children conceived via ICSI is higher than observed in the general IVF population, but the difference between the two groups is small (0.8% to 1.0% in ICSI offspring vs. 0.2% in the general IVF population). Translocations (a re-arrangement of chromosomes that can cause miscarriage) may be more common in ICSI offspring (0.36%) than in the general population (0.07%). Although these differences might result from the ICSI procedure itself, men with abnormal semen analyses are more likely themselves to have chromosome abnormalities and may produce sperm with abnormal chromosomes. These abnormalities could be passed to their offspring.
Some men with extremely low or absent sperm counts have small deletions on their Y chromosome. When viable sperm can be obtained to fertilize eggs with ICSI, sperm containing a Y chromosomal microdeletion may result in male offspring who also carry the microdeletion and may be infertile. A Y chromosome microdeletion can often, but not always, be detected by a blood test.
Men who are infertile because of congenital bilateral absence of the vas deferens (CBAVD) are affected with a mild form of cystic fibrosis (CF). When sperm aspiration and ICSI results in conception, the CF gene will be passed on to the offspring. Men with CBAVD and their partners should be tested for CF gene mutations prior to treatment. However, some CF mutations may not be detected by current testing, so that some parents who test negative for CF mutations could still have affected children.
Surgical Treatments for Male factor Infertility
- Men who present with their partners for a fertility evaluation are often sent to the urologist for a more indepth physical exam. There are times when surgery may be recommended to improve a man’s fertility outcome.
- Varicocoele repair
- Obstruction of the reproductive tract
- Prior vasectomy requiring vas reversal
- Electrical stimulation to help some paralyzed men with ejaculatory dysfunction
Fertility Doctor Tina Koopersmith
Discusses Male Infertility Treatment Options
Together We’ll Find A Way
We pride ourselves on our comprehensive analysis of each man’s health and fertility history before jumping straight into infertility treatment. After all, it’s important to fully consider the many factors that contribute to male fertility. We’re happy to discuss male infertility test options with you so you can choose what’s most suited to your needs.
We look forward to meeting you, learning about you, and helping you to be healthy and happy. To schedule an appointment you can call the West Coast Women’s Reproductive Center at (818) 616-9277 or make an appointment online.