It is estimated that approximately 15% of couples suffer from infertility.1 In 20% of couples struggling with infertility, a male factor is the singular cause and in about 40% of couples, there is a combined male and female cause of infertility.1 Identifying a treatable male factor can improve a couple’s chance of conceiving naturally. Additionally, certain conditions such as testicular cancer can present as male infertility, and an evaluation can aid in diagnosis and prompt treatment.
In couples who fail to achieve a pregnancy after 12 months of regular unprotected intercourse (6 months if female is over 35), a complete evaluation of both male and female is indicated. An initial screen for a male factor usually involves a semen analysis which provides information on semen volume, concentration, motility and morphology. It is important to note that a male infertility factor may be present even when the semen analysis is normal. However, an abnormal result should prompt further evaluation by a specialist in male reproduction. A complete medical and reproductive history and a physical examination are usually part of a detailed evaluation. Hormonal blood tests, ultrasound and genetic screening may also be performed.
Causes of Male Factor Infertility
Causes of male factor infertility fall into two general categories - problems with sperm production or structural problems that block passage of sperm into the ejaculate. Sperm production can be affected by infection, trauma, radiation, genetic defects, medications and use of body building steroids. Certain environmental exposures such as pesticides and chronic heat can also affect sperm production. When sperm production is normal, prior surgeries or infections can cause scarring, leading to blockage of normal passage of sperm. Some men are also born with structural defects that are similarly obstructive. This results in an ejaculate lacking sperm.
A physical exam and detailed evaluation by a male reproductive specialist can help distinguish between these two broad categories, revealing a cause of the abnormal semen analysis. Surgical correction of certain structural defects and/or medical treatment can improve semen analysis results. However in many cases, the cause is not always identified.
Treating Male Factor Infertility
When surgery or medical therapy are not appropriate treatment options, intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) can overcome male factor infertility. The choice of assisted reproduction usually depends on the male factor severity. IUI is used with mild male factor and involves placement of washed motile sperm in the uterus, in closer proximity to the fallopian tubes where fertilization occurs. IVF overcomes any obstacles to sperm movement in the female reproductive tract by allowing fertilization to occur in vitro, using only a few million motile sperm. With severe male factor infertility where only a few motile sperm are present, IVF with ICSI allows for conception with even less sperm, as just one viable sperm is injected into the egg to create an embryo.
In situations where infertility is due to complete absence of sperm, couples have the option of building their families with the use of donor sperm. Screened and quarantined sperm can be obtained from sperm banks for use in assisted reproduction under supervision of a fertility specialist.
At Laurel Fertility Care, skilled reproductive endocrinologists are available to help couples dealing with male factor infertility, working closely with male reproductive specialists. If you have any questions or want to know more about treatment options, please contact us to arrange an appointment.
- Practice Committee of the American Society of Reproductive Medicine. Diagnostic evaluation of the infertile male couple: a committee opinion. Fertil Steril; 2015;103(3):e18-25