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Male Infertility Overview, Causes and Treatments
Male infertility is much more prevalent than previously believed when infertility was largely considered a “female problem”. We now know that up to half of all couples have a male infertility component and infertility is definitely a “couples” problem.
Male infertility occurs when a man cannot produce enough sperm of adequate quality to establish a pregnancy. Sperm are sensitive to temperature changes and the body has evolved means to insure constant testicular temperature. Interestingly, sperm require three months to develop so a semen analysis done today reflects conditions three months prior. This prolonged development period also makes drug treatment of male infertility difficult.
The testicles are contained within the scrotum which expands or contracts in response to temperature. When testicular temperature is “too hot” the scrotum expands to move the testicles away from the body. When the temperature is “too cold” the scrotum contracts bringing the testicles closer to the body. Any activity that interferes with testicular temperature control can lead to decreased fertility.
For example, tight fitting clothes do not allow the scrotum to expand and perform its cooling function. Some occupations require prolonged sitting, such as a long distance truck driver, which also interferes with scrotal function. Activities such as prolonged repeated soaking in a hot tub can also damage sperm.
A common cause of male infertility is a varicocele. A varicocele is a mass of varicose veins in the spermatic cord which interferes with blood flow to the testicles. The circulating blood caries away heat or delivers warmth to the testicles as needed. A varicocele can usually be surgically removed by a urologist.
Unfortunately, there a no clinically proven effective medications to treat male infertility that result in increased pregnancy rates. The exception is the rare male who has severe deficiencies of FSH and LH a condition known as hypogonadotropic hypogonadism.
The most common treatment for moderate to severe male factor infertility is IVF with intracytoplasmic sperm injection (ICSI). Using ICSI, a single sperm is inserted directly into the egg greatly increasing the chances for fertilization. Even men with no sperm in their ejaculate can often father a child using ICSI. In these severe cases sperm can be withdrawn directly from the reproductive tract using TESA or MESA. If the couple decides not to pursue IVF, a sperm donor may be used in an IUI or IVF cycle.
Sometimes men who had a vasectomy seek to have the procedure reversed due to “life changes” such as divorce and remarriage. While surgical reconnection of the tubes is sometimes possible, a vasectomy should be considered a permanent means of birth control. We advise men to store sperm samples prior to the procedure. In many cases, IVF with ICSI offers the best success rates in “post vasectomy” men.
The semen analysis must always be performed prior to any female treatments.