Male Infertility

Lifestyle
Smoking tobacco, using recreational drugs, excess alcohol consumption, and the use of saunas and hot tubs can reduce semen quality. Use of any kind of anabolic steroids or testosterone can also influence sperm production and quality and is strongly discouraged unless medically supervised.

Hormonal Abnormalities
Sperm production is controlled by a series of hormones produced in a small gland called the pituitary. Most men have normal levels of these hormones but occasionally, the pituitary gland can malfunction and production of these these hormones is affected. This in turn affects how sperm is produced.

Varicocele
Enlarged veins which carry blood out of the scrotum can cause blood to pool in the vessels around the testicles. In some patients, this causes the temperature of the testicles to rise, which may lead to reduced sperm production or an increase in the production of abnormal looking sperm. Men who have a varicocele may benefit from sperm washing to improve the quality of the sperm for use in artificial insemination. An improvement in sperm quality may result with surgical repair of the varicocele in some situations.

Blocked Sperm Duct
In some males, the tube that transports the sperm out of the testicles may be blocked or less commonly, not be present. A blockage may be present since birth or have occurred secondary to illness, injury or surgery and therefore be repaired in some men. If the tube is absent, it cannot be replaced.

Sexual Problems
Some couples experience sexual difficulties resulting in problems depositing sperm in the female genital tract. Infrequent sexual intercourse and the use of particular vaginal lubricants may further compound the problem.

Male Infertility Evaluation

The basic test for male infertility is a semen analysis. A semen analysis measures the amount of semen a male produces, and determines the number and quality of the sperm in the sample.

Semen analysis tests include analysis of volume, concentration, sperm count, sperm morphology (percentage of sperm that have a normal shape), pH (acidic level of sperm) and white blood cell count. An abonormality in one or more of these comonents can lead to male factor infertility. There are two methods of assessment of the sperm analysis. There is the WHO method which is commonly used by local sperm analysis labs. ISIS uses a more rigorous assessment called the Kruger strict criteria. For this assessment, the sperm morphology is looked at more critically. Below 4% normal appearing morphology is considered abnormal.

Male Factor Infertility Treatment Options

Once male factor infertility has been identified, there are several treatment options. Which one your doctor will recommend will be based on the severity of the male factor infertility and consideration of any other contributing factors to the infertility problem.

• Intrauterine Insemination
• MESA (microsurgical epididymal sperm aspiration)
• PESA (percutaneous epididymal sperm aspiration)
• TESA (testicular sperm aspiration)
• Vasectomy Reversal

DNA Fragmentation
DNA fragmentation in sperm may be the result of many factors including, but not limited to disease, diet, drug use, high fever, elevated testicular temperature, air pollution, cigarette smoking and age (upper 40's and beyond). DNA fragmentation is a measurement of the amount of “damage” in the chromosomes of the sperm. It is thought that this damage can influence the ability of the sperm to create a viable pregnancy. To complete this test, the male will be asked to provide a sample that will be analyzed by a special lab. It is not clear from research studies if there is a precise cutoff for DNA fragmentation at which pregnancies do not occur or when assisted reproductive techniques cannot compensate. It has been suggested that If the amount of DNA fragmentation is greater than 30%, it is thought that success of achieving a viable pregnancy through assisted reproduction techniques is low though this is currently an active area of research.

Y-Microdeletion
In men that have either no sperm or very low sperm production, this test may show that their infertility is due to a portion of their Y-chromosome is missing. This missing portion is important for producing sperm. This is a genetic test and is done at a specialized lab. The lab analyzes the blood of the male.


Antisperm Antibodies
Antibodies are proteins made by the body’s immune system that fight and destroy foreign substances and prevent infection. There are some antibodies that attack sperm, causing infertility. It is not always certain how the antisperm antibodies affect fertility but it is thought that they may bind to the head or tail of the sperm and limit their ability to penetrate the egg. These sperm are otherwise considered normal. Men who are at risk of having antisperm antibodies are men who have had a vasectomy and then a reversal, surgery or injury to their testicles or a childhood history of undescended testicles. The best way to overcome an issue of infertility due to antisperm antibodies is to do sperm injection straight into the egg (ICSI) at the time of in vitro fertilization.

Karyotype
Some men produce very low amounts of sperm because they have an abnormality in their chromosomes that is affecting the ability to make sperm in the testicles. The frequency of this problem is 10-15% of male factor infertility. The most common cause is an abnormality in the sex chromosomes leading to a condition called Klinefelter’s syndrome. This and other chromosome abnormalities can place a couple at increased risk for miscarriages and for having child with chromosomal and congenital defects. A karyotype is done through a blood test.