Last week, we examined the common signs and symptoms as well as the possible causes of male factor infertility. This week, we shall examine the diagnosis and treatment as well as prevention methods.
The World Health Organization (WHO) defines male factor infertility as the presence of one or more abnormalities in the semen analysis or the presence of inadequate sexual or ejaculatory function and it is the cause for 40 percent of fertility issues couples face.
Couples with the man and woman aged below 35 and not pregnant after a year of trying, or above 35 and not pregnant after six months of trying, should be tested.
The ability to produce sperm is just the tip of the iceberg of fathering a child. Clinically, male factor infertility is the presence of abnormal semen parameters in the male partner of a couple unable to achieve conception after one year of unprotected intercourse. By now, it is known fact that many infertile couples could have more than one cause of infertility. There are instances in which there is combination of male and female factors, therefore it is better for the man and the woman to see the doctor.
It may actually take a number of tests to determine the cause of infertility and determine if it is male or female factor oriented. Investigation into male infertility often begins with questions about sexual habits and sexual development during puberty. Semen analysis is crucial and the semen is generally obtained by masturbating and ejaculating into a special container at the doctor’s office.
Testing a man is simple. All he has to do is ejaculate into a plastic bottle for testing at the fertility clinic. The semen sample is then sent to a laboratory to count the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check for signs of problems such as infections. Often sperm counts fluctuate from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If the sperm analysis is normal, a thorough testing of the female partner may be required before conducting any more male infertility tests.
Additional tests to help identify the cause of infertility can include scrotal ultrasound to help the doctor see obstructions or other problems in the testicles and supporting structures. Tranrectal ultrasound allows the doctor to check the prostate, and look for blockages of the tubes that carry semen. Abnormalities in other hormonal or organ systems may also contribute to infertility. A blood test measures the level of testosterone and other hormones. Sperm in urine can indicate sperm are traveling backward into the bladder instead of out the penis during ejaculation (retrograde ejaculation). When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality.
Genetic testing may also be ordered to diagnose various congenital or inherited syndromes. The results of the testicular biopsy will tell if sperm production is normal. If it is, the problem is likely caused by a blockage or another problem with sperm transport. Anti-sperm antibody tests are used to check for immune cells (antibodies) that attack sperm.
A man is especially likely to have anti-sperm antibodies if he has had a vasectomy reversal. A number of tests can be used to check how well sperm survive after ejaculation, how well they can penetrate an egg, and whether there’s any problem attaching to the egg. Fertility can be improved by either correcting an underlying problem or trying treatments that seem like they may be helpful. Often the exact cause of infertility may not be apparent but even if an exact cause isn’t clear, the clinician may be able to recommend treatments that work.
Antibiotic treatment may cure an infection of the reproductive tract, but doesn’t always restore fertility. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation. Assisted Reproductive Technology (ART) treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Sometimes male fertility problems can’t be treated, and it’s impossible for a man to father a child. In such cases, consideration is between using sperm from a donor and adopting a child.
About 3 in 4 men with a male factor will have identifiable or treatable conditions that affect their fertility, and from clinical experience, nearly all men with male factor infertility are treatable with assisted reproductive techniques. Evaluation and treatment of a man with male factor is worthwhile, despite the recent advances in assisted reproduction.
Male factor infertility is treatable with IVF except if advanced age of the female partner is present. If severe male factor infertility is present, direct treatment with IVF and micromanipulation may be indicated.
Steps that can be taken at home to increase chances of achieving pregnancy abound. One is to increase frequency of sex. Having sexual intercourse every other day around the time of ovulation increases the woman’s chances of getting pregnant. However, ejaculating more often may reduce sperm count. A woman is likely to become pregnant during her ovulation which occurs in the middle of the menstrual cycle, between periods.
We generally recommend having intercourse every two days near the time of ovulation. This will ensure that sperm, which can live several days, are present when conception is possible. Avoid the use of lubricants like K-Y jelly, lotions, and saliva that have been shown to reduce sperm movement.
Coping with male infertility can be difficult. It’s an issue of the unknown and you can’t predict how long it will last or what the outcome will be. Infertility isn’t necessarily solved with hard work yet the emotional burden is considerable, and plans for coping can help. So it pays to plan. A successful pregnancy often depends on repeated attempts. There are several types of male infertility that aren’t preventable. Some of the known causes include smoking, alcoholism, drug use, obesity, stress, exposure to pesticides, heavy metals and other toxins.
