Dr. Geoffrey Sher
Owner, Sher Fertility Solutions
Male factor problems as a contributing cause of infertility are very common – up to 30-50 percent of infertility cases. In fact, many fertility specialists will recommend a semen analysis as one of the very first tests that should be done. It is relatively simple and inexpensive, and yields much information.
The two main causes of male infertility can be divided into problems in manufacturing sperm or problems in getting sperm outside of the body (ejaculation of viable sperm).
Sperm manufacturing problems can reside in the testicle or from signaling problems from the brain to the testicle. Problems in ejaculation of sperm can arise from obstruction of the ducts that carry sperm to the outside (such as previous vasectomies) or spinal cord injuries resulting in damage to nerves that innervate the testicle and male reproductive tract.
Screening for infertility
The initial work-up for sperm problems should include a comprehensive semen analysis which will evaluate the semen against fertility standards. These include the volume of the ejaculate, concentration of sperm, motility, and morphology. The semen analysis will frequently drive the remainder of the male evaluation if warranted. These tests will assist in determining if the problem lies in the proper signaling of the testicle from the brain in order to manufacture sperm.
Additional evaluations, including but not limited to blood karyotyping, will further assist in determining if there is a chromosomal or genetic abnormality in the male causing lack of sperm manufacturing.
Once these are ruled out, then issues of obstruction must be considered. This will usually involve a urologist who specializes in male infertility. After a thorough history and physical exam, a urologist might perform an ultrasound of the testicle, a dye test (vasogram) of the male reproductive tract, and possibly a biopsy of the testicle. There are all rather minor procedures that require very little down time.
There are various potential treatments of male factor infertility, including hormonal treatments to try and improve production of sperm to ligation of veins that feed the testicles (varicocelectomy); the performance of intrauterine insemination (IUI); and in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).
In severe cases, it might be necessary to biopsy the testicle, a procedure called testicular sperm extraction (TESE). The biopsied sperm cells can then be injected in to eggs to attempt fertilization. This procedure can diagnose as well as treat severe male factor cases. Some cases of male factor infertility are beyond using the male partner’s sperm, and in such cases, there is still hope by using donor sperm. The use of donor sperm is safe and effective.