Male Infertility

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 45% 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.

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 such as WHO criteria or Kruger Strict Criteria. Generally, sperm count, volume, shape, viscosity, swimming ability, and liquefaction are all important measurements.

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.

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 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 ICSI. 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 by ICSI.