Infertility was considered “a female problem” for many years until it was discovered that a male component is present in up to 47% of couples. Therefore, treatment of the female should not begin until there has been a thorough evaluation of the male.
The male must produce and ejaculate a sufficient number of “quality” sperm into the vagina. These sperm must be capable of reaching, penetrating, and fertilizing an egg. The male evaluation consists of the semen analysis which is discussed in the male fertility section.
Male infertility is present in up to half of all infertile couples and must be ruled out early in the workup. Our fertility clinic offers the semen analysis for men with infertility “on site”
Sperm require three months to develop meaning a sample taken today is indicative of conditions affecting sperm quality/quantity three months ago. Likewise, any treatments or changes in lifestyle will not be evident for three months. This means that if the male makes like style changes or undergoes medical / surgical treatment today, the change will not “take effect” until after the three month period.
Sperm can be affected by many factors including infection, occupation, environmental toxins, hormone interactions, and conditions such as a varicocele. The optimal temperature for sperm production and storage is maintained by the scrotum. The scrotum expands and contracts in response to temperature changes thus moving the testicles further away (cooling) or closer (heating) to the body. Activities such as prolonged, regular, sitting in a hot tub can interfere with scrotal cooling leading to a decline in sperm count. Fortunately, many of these factors leading to infertility in men can be controlled by the patient. Our fertility clinic provides extensive education as to the causes of infertility and the suitable treatments.
A varicocele is a collection of varicose veins in the scrotum. Normal blood flow carries warmer blood away from the scrotum resulting in scrotal cooling. A varicocele can significantly interfere with blood flow (cooling) leading to increased scrotal temperature. Varicoceles are sometimes treated surgically by a urologist.
Other factors such as smoking, heavy metal exposure, marijuana and testosterone supplements have been shown to reduce sperm count and quality. Rarely, a man will produce antibodies to his sperm. Antibodies mistakenly identify the sperm as invading pathogens, similar to bacteria and viruses, and seek to destroy them. Antibodies usually result from some type of testicular trauma where sperm cells are exposed to blood. Antisperm antibodies commonly form following vasectomy. IUI is often a treatment of choice because the sperm are placed directly into the uterus thus avoiding the cervical mucus.
Rarely, hormonal deficiencies negatively impact sperm production. Normal spermatogenesis requires that the hypothalamus “stimulate” the pituitary to produce FSH and LH. Both of these hormones bind to receptors in the Sertoli cells (produce sperm) and Leydig cells (produce testosterone). The production of testosterone stimulates sperm production and development.
Hypogonadotropic hypogonadism is characterized by extremely low levels of FSH and LH and reduced sperm count. This condition can often be medically treated using hCG or a combination of FSH and LH. Our fertility specialist are acutely aware of the many conditions that can lead to infertility in men