Diagnosis and Treatment of Male Factor Infertility￼
Infertility is a disease affecting about 10% of women and 9% of men in the United States. Despite raised awareness that “it takes two to tango”, most people I still meet TODAY, think of infertility as being a “female” issue. Many are surprised to find out the diagnosis of male factor infertility is identified in up to 40% of opposite sex couples.
Given these facts, it is important that we approach infertility with a comprehensive strategy and test and support both men and women.
So how do we begin?
First steps to diagnose Male Factor Infertility – History & Physical
A thorough history is important in narrowing down possible factors contributing to male factor infertility. Exposure to toxic fumes or chemicals? Are there any medical conditions which could affect sperm production or its function? Is there a history if decreased libido or erectile dysfunction? Prior testosterone use? Prior surgery such as hernias, testicular torsion, testicular cancer? In addition, patients who have an abnormal semen analysis may benefit from consult with a reproductive urologist for a physical exam. At times, serum samples may be ordered to evaluate conditions affecting sperm production such as disorders of the pituitary gland or thyroid dysfunction, or conditions such as testicular hypofunction and failure.
Semen Analysis for Male Factor Infertility
Since 1930’s, the semen analysis has been integral to the evaluation of infertility. Today, after many iterations of morphological assessment and improved microscopes and lenses, the semen analysis is performed by an andrologist, a scientist trained to provide parameters that clinicians can use to guide patient care. The semen analysis is usually performed by masturbation into a sterile production cup after a period of 2 to 5 days of abstinence. It is advisable to avoid lubricants which could interfere with the quality of the sperm being evaluated. The results provided include mainly seminal fluid volume, sperm concentration, sperm motility, including progressive motility, sperm morphology, and evaluates sample viscosity and presence of white blood cells, the latter being indicative of a possible infection. If the results of a semen analysis are abnormal, it is usually repeated within at least 4 weeks apart.
Reasons For Male Factor Infertility
Low sperm count/Poor sperm motility
Oligospermia, or low sperm count, can be treated if a specific etiology is found such as thyroid dysfunction, elevated prolactin, weight loss for obese men. However, most cases do not have a specific cause and are deemed idiopathic. At times, a reproductive urologist can prescribe medications to boost sperm production such as clomid or injectable gonadotropins. These could raise the sperm count thereby allowing an opposite sex couple to try to conceive spontaneously or with the use of intrauterine insemination. Poor sperm motility, or asthenospermia, could suggest a history of prior testosterone use, an infection of the urogenital tract, exposure to toxins such as excessive tobacco or alcohol, use of hot baths/saunas – as these can raise testicular temperature, or an unexplained etiology. Behavior modification and use of vitamins and supplements decreasing oxidative stress and free radical formation may be helpful. A varicocele is an anatomical variant where vessels around the vas deferens are dilated and could cause both poor sperm motility and morphology. An intrauterine insemination, or an IUI, is a procedure whereby the male partner produces a sperm sample and following a sperm wash, the sperm is concentrated in a small volume. This concentrated sperm sample is then aspirated into a soft catheter which is subsequently introduced through the female partner’s cervix and the sample is left inside the uterus. This procedure is performed after careful monitoring of the female partner’s ovulation so that the “fertile window” is not missed. In cases where the count and or motility are so compromised that an IUI is not likely to lead to success, in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) may be necessary. While these treatments may be labor intensive and demanding from both partners, success rates are very favorable, particularly with the use of ICSI.
Poor sperm morphology can cause male factor infertility
The presence of poor sperm morphology, or teratozoospermia is associated with an increased time to pregnancy. So, while it does not preclude an opposite sex couple from conceiving, it certainly could contribute to a longer time to conceive. In some cases, behavior changes such as tobacco, alcohol, or marijuana reduction or cessation may be necessary.
There is NO sperm!
Azoospermia, or no sperm found in the ejaculate can be categorized into obstructive and nonobstructive. The most common case of obstructive azoospermia is a history of vasectomy. These cases tend to lead to success, often with the use of assisted reproductive technology and intracytoplasmic sperm injection of testicular sperm extraction when a vasectomy reversal cannot be successfully performed. Non-obstructive azoospermia cases have poorer prognosis with some cases such as Sertoli cell only syndrome requiring the use of donor sperm for conception.
According to the World Health Organization, men are 3.5 times more likely than women to commit suicide, likely due to societal pressures to handle things “on their own’.
The diagnosis and treatment of male factor infertility is very individualized. Moreover, the emotional and psychological toll it places on both partners varies depending on the dynamics of the relationship. According to the World Health Organization, men are 3.5 times more likely than women to commit suicide, likely due to societal pressures to handle things “on their own’. Currently, there is still a paucity of studies focusing on the psychological effects of male factor infertility on the male partner. As we continue to raise awareness of this common and often treatable condition, we hope to continue to normalize these conversations and focus on successful interventions.
If you have questions about Male Factor Infertility or any other fertility issue, please contact us. You can call my team at 732.786.7900, or reach out to us via our website or social media accounts. I offer telemedicine and in person consultations.
Dr. Jessica Salas Mann is board certified in both Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. She is a fellow of the American College of Obstetrics and Gynecologists, and is a Diplomat of the American Board of Obstetrics and Gynecology. Dr. Mann and her team deliver exemplary care and service to patients throughout Central and Southern New Jersey at her office in Old Bridge. She is an experienced reproductive surgeon, having served the patients of Middlesex, Monmouth and Ocean counties since 2011. Her areas of clinical interest and expertise are pregnancy loss, ovulation induction, in vitro fertilization, polycystic ovarian syndrome, and third party reproduction.