Male Infertility Evaluation
Infertility was once considered a female problem, but we now know that male infertility is a major contributing factor in many couples’ inability to conceive.
In fact, male factor infertility is present in up to half of couples. The prevalence of male infertility makes the semen analysis one of the most important fertility tests, and it should be performed prior to any female therapy.
Male infertility means that a man may not deliver the appropriate quantity or quality of sperm to reach and fertilize an egg. Sperm are manufactured in the testicles and travel through the epididymis and the vas deferens when ejaculated. Sperm require three months to develop, which means a semen analysis done today is reflective of the conditions three months earlier. The conditions that originally caused male infertility may no longer be present.
Biological Requirements for Male Fertility
- The male must produce sufficient sperm of acceptable quality to cause fertilization.
- The sperm must be ejaculated into the female’s vagina.
- Once ejaculated, the sperm must swim in the cervical mucus into the uterus and to the end of the fallopian tube, where fertilization occurs.
- The male gametes (sperm) must be genetically normal and able to penetrate and fertilize an egg.
Male infertility can be caused by many factors.
Sperm are sensitive to temperature, and chronic exposure of the testicles to heat can lead to subfertility. Activities such as prolonged regular hot tub use can artificially raise the testicular temperature, as can tight-fitting clothing. Certain occupations, such as long distance drivers, can interfere with temperature regulation. Other occupations may cause exposure to spermatotoxic agents such as heavy metals. Any of these conditions can lead to male infertility, especially if the cause is repetitive. Male infertility can also be caused by a varicocele.
A varicocele is a collection of dilated varicose veins in the spermatic cord. These veins carry blood away from the testicles, thus performing a cooling function. A varicocele can interfere with the normal blood flow and raise the testicular temperature, leading to semen abnormalities, such as decreased count or motility. Although there is some debate as to whether varicoceles need to be repaired surgically, the presence of moderate to severe varicoceles that lead to an abnormal semen analysis generally deserve serious consideration for surgical repair.
Male infertility is sometimes caused by the male developing antibodies to his own sperm, which increases agglutination in the semen. This usually results after a trauma to the testicles or surgical procedures such as a vasectomy reversal. When present, antisperm antibodies can bind to the sperm, essentially interfering with fertilization and motility.
Male infertility cannot usually be treated effectively with fertility drugs.
If a man is severely deficient in FSH and LH, a condition known as hypogonadotropic hypogonadism, he can sometimes be treated with medications (Clomid or gonadotropins). These treatments are very expensive and can take several months to be effective. Numerous products, including natural supplements, are advertised as being effective in improving sperm quality. While many claims are made, the true benefits are debatable. Clomid is usually not effective in treating other causes of male infertility.
Sometimes a man may seek reversal of a previous vasectomy. While reversal is often possible, a vasectomy should be considered a permanent method of birth control. Whether or not the tubes can be reconnected depends upon many factors, including where and how the tubes were cut. Still, without a successful vasectomy reversal, sperm can be biopsied from either the epididymis or testicle for IVF with ICSI.
Moderate to severe male infertility can be treated using intracytoplasmic sperm injection (ICSI), which is an excellent option for many couples. In ICSI, a single sperm, which is collected by masturbation or biopsy, is injected directly into the egg. ICSI makes it possible for a man to father a child even though there may be no sperm in the ejaculate. Sperm can be obtained directly from the reproductive tract using testicular sperm aspiration or microsurgical epididymal sperm aspiration.