Male Fertility
About 40% of infertility is associated with male factors. If a man does not produce enough sperm, or if the shape (morphology) or ability to swim (motility) of the sperm is impaired, then the sperm will be unable to fertilize the egg.
Today there are more treatment options than ever for men with fertility problems. New procedures have revolutionized the treatment of male infertility by providing the technology to retrieve sperm and fertilize an egg with a single live sperm.
Procedures include:
- Intracytoplasmic sperm injection (ICSI)
- Microepididymal sperm aspiration (MESA)
- Testicular sperm extraction (TESE)
HORMONAL PROBLEMS
In order to produce healthy sperm, a man’s body must secrete just the right balance of testosterone and gonadotropin hormone.
Hormonal imbalances may be the result of a dysfunction in the interaction between the hypothalamus, the pituitary gland, and the testes. This can affect sperm production or the production of the seminal fluid.
Treatment
Hormone therapy is not usually effective in treating male factor infertility, but a small percentage of infertile men can be treated with gonadotrophin therapy. ICSI is usually the treatment of choice for men with hormonal problems.
Physical abnormalities
Structural problems with male reproductive organs can block the passage of sperm or impair your ability to produce healthy sperm. These problems can often be repaired with surgery or with other treatment measures.
Common abnormalities include:
- Blockage
- Hydrocele
- Retrograde ejaculation
- Undescended testes (cryptorchidism)
- Varicocele
- Vasectomy
Blockage
Any sort of obstruction in the sperm ducts, vas deferens, or urethra can prevent the sperm from being ejaculated.
Causes
Blockages are often caused by infections, including sexually transmitted diseases.
Treatment
- Surgery to repair blockage
- Antibiotics to cure the underlying infection
- Testicular biopsy to surgically retrieve sperm if a blockage cannot be repaired
Hydrocele
A hydrocele is a rare condition when a small bag of water is present in the scrotum (the sac of skin surrounding the testicles).
Treatment
Surgical removal of the hydrocele.
Retrograde ejaculation
Retrograde ejaculation is when a man ejaculates semen into the bladder instead of through the penis.
Causes
This happens when the valves that control the flow of urine and semen malfunction and can be the result of diabetes or the removal of the prostate gland.
Treatment
A man with retrograde ejaculation can have his sperm retrieved from his bladder or from a treated urine sample.
Undescended testes (cryptorchidism)
Sometimes a boy’s testes do not descend into the scrotum during childhood. This can cause fertility problems, as the testes need to be a few degrees cooler than body temperature for normal sperm production to occur.
Treatment
Surgery can repair undescended testes, but permanent damage can sometimes result if the testes do not descend in childhood.
Varicocele
Varicoceles are the result of varicose (enlarged) veins in the testicle. This can impair fertility by increasing the temperature in the testicle and reducing sperm production.
Treatment
Surgery can repair varicoceles.
Vasectomy
A common reason for the absence of sperm is a previous vasectomy. Men can have a medical procedure done to reverse the vasectomy. The success of the procedure depends on how long ago the vasectomy was performed. If you had a vasectomy more than five years ago, you may have a lower chance of having a successful reversal.
Treatment
A vasectomy reversal involves reconnecting the man’s vas deferens or stitching the vas directly onto the epipidymis. If the vasectomy was done more than five years before the treatment or if the reversal fails, there are excellent techniques to retrieve the sperm from the epipidymis or testes for use in ICSI and IVF.
Infection and Disease
Many health conditions or diseases, including diabetes, cystic fybrosis and mumps, or any illness that causes an extended period of high fever can reduce sperm production.
Untreated infections can cause structural damage or affect the healthy production of sperm. As sperm are being continually produced, the effects of infection may be reversible, if no scaring or blockage has occurred, and sperm function may be restored over time.
Treatment
In the case of infections like STD or urinary tract infection, antibiotics can treat the infection. If structural damage has occurred as the result of the infection, surgery may be needed as well. If surgery can’t restore fertility, then ICSI is an option.
Cancer
Cancer is a frightening illness that can affect every aspect of a man’s life, including his future ability to father children.
Cancer can impact fertility in several ways:
- Chemotherapy and radiation can damage and destroy the cells in the reproductive system
- Sterility is a side effect of many cancer-fighting drugs
- Cancer treatment may require the removal of reproductive organs, resulting in a compromised reproductive system
If you are facing cancer treatment and wish to preserve your fertility, you can have multiple sperm samples frozen (cryopreservation) before your treatments.
Genetic conditions
Klinefelter’s Syndrome is a chromosomal disorder in men where there is no or low sperm count.
Causes
Klinefelter’s is the result of having an extra X chromosome (XXY instead of XY).
Treatment
If the man is still producing sperm, the doctor can retrieve sperm from the testes with a minor procedure called a testicular biopsy and use ICSI to fertilize the partner’s egg.
Klinefelter’s is inherited, and as there is a chance of passing along the extra X chromosome to the potential offspring, couples should discuss their situation with a genetic counselor. If you have this condition, you may choose to have pre-implantation genetic diagnosis (PGD) to check the health of the embryos before implantation.
Age
Although age has more impact on women’s fertility, increasingly, studies are showing that age also contributes to male infertility.
Changes that occur in male fertility as a result of aging include:
- Decreased testicular function
- Decreased hormone levels
- Decreased sperm production
Treatment
Again, ICSI is the best treatment option for decreased sperm production.
Immune problems
About 10% of infertile men produce antisperm antibodies that interfere with the quality or function of the sperm. Antisperm antibodies occur when the normal barrier that protects the sperm from antibodies is broken down and the body becomes sensitized to sperm, causing an immune system response that destroys the sperm.
Causes
There are many reasons why antisperm antibodies occur. Anything that interferes with the natural barrier between sperm and the immune system can put you at risk of developing this condition. Some common causes of antisperm antibodies include:
- Infection
- Undescended testicles
- Twisting of the testicles
- Injury to the testicles
- Testicular biopsy
- Testicular cancer
- Varicocele
- Congenital absence of the vas deferens (CAVD)
- Vasectomy reversal (especially likely)
Treatment
A sperm analysis can tell you whether or not antibodies are present. Most couples affected by this condition will need assisted reproductive technologies in order to conceive. Washing the sperm before IVF or intrauterine insemination can improve the chances of producing fertilized eggs for implantation.