Male Infertility

Abnormalities in semen parameters accounts for approximately 20% of infertility cases and is a contributing diagnosis in another 20-40% of infertile couples. As a result, evaluation of sperm is a vital portion of the infertility work-up. This is performed by obtaining a semen sample from the ejaculate following masturbation after 2-3 days of abstinence.

WHO parameters of lower reference limits for semen analysis in fertile men includes:

• Volume: 1.5 (1.4-1.7) mL
• Concentration: 15 (12-16) million/mL
• Total sperm number: 39 (33-46) million/ejaculate
• Total motility: 40 (38-42) %
• Progressive motility: 32 (31-34) %
• Normal morphology: 4 (3-4) %

If the first semen analysis demonstrates abnormal results, it is often repeated. This is because there may be large variations between sperm samples and confirmation of largely abnormal semen analysis results is an important step to proceed with additional testing. Unfortunately, most causes of male infertility remain unknown and may not be amenable to treatment however a number of causes can be treated to improve pregnancy outcomes.

Causes Of Male Infertility

Male infertility can be due to a number of different causes, some that are reversible and others that require fertility treatments including intrauterine insemination (IUI), in vitro fertilization (IVF) with or without sperm extraction, or use of donor sperm. In some cases, after an initial evaluation, you may be referred to a reproductive urologist for a more comprehensive assessment and treatment.

Listed below are the more common causes of male infertility:

• Varicoceles: bulging veins of the testicles
• Infections:
  • Mumps is a childhood infection that can result in orchitis (inflammation of the testicles) which can results in low sperm production, although rare this more commonly occurs in unvaccinated men
  • Epididymitis most often caused by sexually transmitted infections (Gonorrhea, Chlamydia) or other bacteria (tuberculosis), is inflammation of the epididymis- the tube connected to the testes that transports sperm. If scar tissue forms, this can result in partial or complete blockage which can block the sperm from leaving the testes
• Environmental toxins: Exposure to heat, smoking, marijuana, heavy metals, pesticides, endocrine disrupting chemicals can significant impact sperm parameters
• Genetic mutations or chromosomal abnormalities:
  • Klinefelter syndrome which is the presence of an extra X chromosome (XXY males)
  • Y chromosome deletions (some deletions are more severe than others, regarding the degree of infertility)
  • Single gene mutations within genes that are involved in the control of sperm production
• Hypogonadotropic hypogonadism: failure of the brain to secrete important signaling hormones (FSH and LH) for the growth and development of sperm. This could be due to inherited or sporadic mutations, presence of a brain tumor and other infiltrative brain diseases or obesity
• Chemotherapy or radiation: male cancer patients who have received chemotherapy or radiation may have testicular failure which is irreversible
• History of vasectomy: results in permanent obstruction of the vas deferens (this is what transports sperm into the ejaculate)
• Congenital absence of the vas deferens: some men with a CFTR mutation are born without the tube that transports sperm from the testes to be mixed with semen
• Drugs: including anabolic steroids, opiates, testosterone, glucocorticoids. It is important to disclose all drugs you are taking in order to help determine the cause of your infertility
• Ejaculatory dysfunction: this may be due to spinal cord disease as well as other emotional or psychologic conditions
• Retrograde ejaculation: also known as a “dry orgasm”, this is where the ejaculate is not properly expelled

Evaluation

General evaluation of the cause of male infertility in our office includes:

• Medical history and physical exam
• Semen analysis
• Hormone and/or genetic testing
• If additional work-up including biopsy is required, you will be referred to a male reproductive urologist

Treatment of Male Factor Infertility

Treatment varies based on diagnosis however services offered at IVF Phoenix include

• IUI: after collection, sperm is washed to remove any dead sperm or debris and placed directly into the uterus
• IVF with intracytoplasmic sperm injection (ICSI): this involves injection of a single sperm into a mature egg to create embryos
• Hormone therapy, if indicated
• Additional treatments such as surgical sperm retrievals are referred to a male reproductive urologist