The Male Factor

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In general, infertility is due to male factors one third of the time, female factors one third of the time and both one third of the time, so men really represent half of overall infertility cases.When we check for male infertility we look at the semen analysis, and that comprises sperm count, motility – that’s how they are swimming and how they are shaped that’s called morphology. If a man has a normal semen analysis, he is probably fertile, but not in all cases.

My advice to most men is to live a healthy life meaning eat a normal diet, stay within ideal body weight be moderate in alcohol intake, not smoke and not surround the genital area with prolonged heat exposure such as long distance bike riding. The use of a male formula vitamin with high amounts of anti-oxidants are also very helpful in maintaining sperm health.

One of the biggest no-no’s though is testosterone. Testosterone is basically a contraceptive, if a man takes testosterone he is wiping out his sperm and unfortunately that’s not commonly known. All men with a significantly abnormal semen analysis really should have an evaluation by a urologist to make sure they don’t have other health issues that need to be treated.

Some of those causes can be quite serious such as genetic problems, tumors, endocrinal hormonal problems. For men who have moderate abnormalities on their semen analysis we can improve their chances by doing intra-uterine inseminations called IUI also known as artificial insemination. We basically take the semen and wash it and get the best swimmers the A team out and then we introduce those swimmers into the partner’s uterus using a soft guide at the right time of the month.

When men have very severe semen analysis abnormality such as very low count or very low motility we can actually take the sperm and inject it directly into the egg, it’s called the intra-cytoplasmic sperm injection which is known as ICSI. Many men have become fathers because of this revolutionary procedure. It is very effective in fertilizing eggs.

Men who have had a vasectomy and want to have more children can either have a vasectomy reversal or have the sperm harvested directly from the testicle or the holding tank near the testicle called the epididymis and that’s because vasectomy is a procedure where the ejaculatory duct is blocked surgically.

When it comes to the male partner infertility, we have had a long history of overlooking the real impact that men may have on conception and babies for many years we have trusted the semen analysis as our gauge of male infertility. In fact it is not as reliable as we thought it was. Ten years ago we started looking inside the sperm at the DNA and seeing if the DNA was fragmented and broken up.

Turns out that fragmented DNA if in high percentage can impact pregnancy and it can impact embryo development and the chance of pregnancy and even miscarriage. Treatment with anti-oxidants and vitamins actually has shown to be helpful in such conditions. More recently as the exciting area of epigenetics a phenomena where men through their lifestyle and medical condition put molecules on the DNA of sperm.

And those molecules can influence how the genes of sperm work and can impact embryo development early pregnancy loss and even trans generationally children, grandchildren and great grandchildren. So what a man eats, his medical conditions, his lifestyle choices really can impact the outcome of a pregnancy now and for future generations.

So we are now opening up this very exciting era in understanding male fertility and I think we are going to improve the outcomes of pregnancy by improving our assessment of sperm and modifying that man’s health as it comes to sperm.

In about 40% of infertile couples, the male partner is the sole or a contributing cause of infertility. A semen analysis is important in the initial evaluation. To prepare for a semen analysis, you will be asked to abstain from ejaculating for at least 48 hours. The male patient then will collect a semen sample in a cup by masturbating at home or in the physician’s office. In some instances, a semen sample may be obtained during sexual intercourse using a special condom provided by the physician.
The semen specimen is examined by microscope to determine the volume, motility, and morphology of the sperm. Sometimes two or three semen analyses are required over two to six months, as sperm quality can vary over time. Other hormonal or genetic tests may be recommended as well, depending on the type and severity of abnormalities found.

If the semen analysis reveals abnormalities, he may need to consult a clinician who specializes in male infertility. Treatment for male factor infertility may include antibiotic therapy for infection, surgical correction of varicocele or duct obstruction, or medications to improve sperm production. In some men, surgery to obtain sperm from the testis can be performed. In some cases, no obvious cause of poor sperm quality can be found. Intrauterine insemination (IUI) or IVF may then be recommended. Direct injection of a single sperm into an egg (ICSI) may be recommended as a part of the IVF process.
If no sperm are present on semen analysis or not found at surgical extraction, your physician may discuss using a sperm donor. Insemination with donor sperm may also be considered if IUI is not successful or if you and your partner do not choose to undergo IVF.


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