Male infertility accounts for 30-40% of infertility. Male infertility is usually related to abnormal sperm production or function.
Problems can occur anywhere in the production of sperm including hormonal regulation, storage, and transport of sperm. Genetic abnormalities can also contribute to decreased sperm or abnormal function. Fortunately, there are treatments that can help improve a couple’s chances of becoming pregnant.
Usually, the first step in evaluating for male infertility is a semen analysis. This is an analysis for the assessment of morphology, sperm count, motility, and total motile sperm.
Normal parameters for a semen analysis:
- Total Sperm Count > 40 million
- Morphology (WHO) > 30% normal shape
- Morphology (Kruger) > 14% normal shape
- Volume > 2 milliliters
- Motility > 50% motile
- Liquefaction complete by 60 min
Total motile sperm count is the amount of moving sperm in the entire sample. This value is also used as an indicator of the overall assessment of the semen. An abnormal semen analysis will usually prompt further investigation including hormonal investigation, testicular examination, and in some instances, a chromosome analysis.
Testing pituitary-gonadal hormones can provide valuable information on the state of sperm production. In turn, there are abnormalities of these hormones that can cause infertility. The standard hormone evaluation includes an FSH, , LH, and prolactin.
Hormone levels should be measured if:
1) Sperm concentration is <10 x 106 sperm/ml on semen analysis.
2) There is impaired sexual function (erectile dysfunction, low libido)
3) There are exam findings of a specific hormone disorder (i.e. thyroid).
The more common patterns of hormonal disorders seen with infertility are in this Table.
|Primary Testis Failure||Low||High||NL/High||NL|
TABLE : CHARACTERISTIC HORMONE PROFILES IN INFERTILE MEN.
Procedures involved male problem solving
When physical barriers to sbullet1perm production exist, there are specific procedures that can help. Below is a brief sample of some of the procedures performed for male infertility:
Vasectomy reversal – for men using a vasectomy for birth control, their vas deferens has been interrupted to prevent the passage of sperm. A vasectomy reversal can restore the opening in some cases. Sperm may also be retrieved by testicular aspiration and combined with ICSI. Antisperm antibodies can often be a problem. It is not uncommon to see declining sperm counts over time with a vasectomy reversal.
Varicocele ligation – when excessive dilation of the blood vessels around the testicles occurs, excessive heat builds up. The vessels, or varicocele, can be ligated and allow the testis to return to normal temperatures.
Testicular Sperm Extraction (TESE)or Testicular Sperm Aspiration(TESA) – this term is applied to the procedure involving sperm aspiration or retrieval from the testicle. Essentially this is a testicular biopsy performed for treatment purposes as opposed to diagnostic purposes.There is a higher likelihood of immature sperm and the sperm retrieved will likely be in low numbers. ICSI is essential following most biopsy and aspiration procedures.
Microsurgical Sperm Aspiration (MESA) or Percutaneous Epididymal Sperm Aspiration (PESA) – are procedures where sperm is retrieved from the epididymis. Epididymal sperm usually contains more mature sperm .
Intracytoplasmic sperm injection (ICSI) is a procedure used when sperm counts or other parameters are below the normal threshold. A single sperm is isolated under the microscope and used to inject directly into an egg. Ideally there are enough sperm to fertilize all of the oocytes. Motile, forward moving, and normal appearing sperm are preferred in the process of choosing a sperm.
The correct procedure and options will be discussed with you prior to proceeding with any treatment. The procedures can usually be performed right in our clinic. Sperm aspiration techniques and surgical correction of anatomical problems has given many couples hope. Donor sperm represents an alternative to these surgical procedures. Couples should make an informed decision about the options that are suitable for them.