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Male Infertility- An Overview
Male infertility is now recognized as a major contributing cause to many couples infertility. Society once judged infertility
to be primarily a "female problem". Male infertility has been shown, by well controlled scientific studies, to be present in up to 47% of infertile couples. This fact makes the semen analysis one of the most important fertility diagnostic tests. Sperm abnormalities must be "ruled out" before any female therapy can be initiated.
Diagnosis of male infertility has a special caveat in that sperm examined today actually began their development three months prior. The quantity and quality of sperm seen today are influenced by factors that were present three months past which may, or may not, have changed or still be present.
Male fertility requires that the
male produce an adequate quantity of "quality"
sperm that can be ejaculated into the vagina. Once ejaculated,
the sperm must be capable of swimming through the cervix,
into the uterus,
and to the distal end of the fallopian tubes. A sperm
must attach to, and penetrate, the zona pellucida (membrane
surrounding the egg) and fertilize the egg.
Male infertility can be caused by many different factors, which are evaluated during the semen analysis. Laboratories use different evaluative criteria and many fertility labs use the Kruger Strict Criteria.
We have a separate page devoted to interpreting the semen analysis. Generally,
sperm count, volume, shape, viscosity, swimming ability,
and liquefaction are all important measurements.
Male infertility should be evaluated by a reproductive medicine laboratory. Sometimes managed care plans dictate the least expensive laboratory, which may, or may not, have staff specially trained to evaluate semen. Most reproductive medicine labs employ andrologists with years of experience evaluating sometimes subtle sperm abnormalities.
Male infertility can be caused by
environmental factors such as certain chemicals, some
occupations, and routinely sitting for long periods
in a hot bath or hot tub. The scrotum expands or contracts thus moving the testicles further, or closer, to the body regulating temperature.
Male infertility can also be a consequence of a varicocele, which is a collection of varicose veins
in the scrotum, which can interfere with blood blow and thus inhibit heating and cooling of the testicles. A varicocele is usually treated surgically by a urologist.
Male
infertility can also result when antisperm antibodies are present. Antibodies "mistake"
sperm as foreign pathogens and seek to destroy them.
Rarely, a man may produce antibodies to his own sperm usually as a result
of testicular trauma or surgery such as vasectomy. The antisperm antibody process is similar to the bodies response when challenged by virus or bacteria. The body makes antibodies to destroy the specific invading pathogens, and in cases of male antisperm antibodies, sperm. When antisperm antibodies are present, IUI is often the treatment of choice since the procedure avoids the cervical mucus, where the antibodies reside.
Unfortunately, there are very few
cases where fertility drugs are effective
in treating sperm and/or semen abnormalities. If a drug is administered,
it usually requires three months to exert its effects, is very expensive,
and rarely significantly improves sperm parameters.
The exception to this is the male who is severely hypogonadotropic
(extremely low levels of FSH and LH).
Moderate to severe male infertility can often be treated using IVF with ICSI.
Oftentimes, a single sperm can be obtained from the
male reproductive tract and injected directly into the
egg. This means that a man with no sperm in his ejaculate
may be capable of producing a genetically related child.
Please see our discussion of ICSI on the IVF Web Site.
Sometimes men who had a vasectomy
want to have the procedure reversed. Although vasectomy should
be considered a permanent means of birth control, life's
circumstances change and many men seek reversal. The vas deferens can sometimes be reconnected
surgically. Please see Dr.
Feinman's article on this topic.
The good news is that the vast majority
of infertile men can father children with proper infertility
specialist care.
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