Male
Infertility
Male factors alone cause infertility in 20%–30% of couples. Men contribute to infertility in another 20%–30% of couples. Overall, about half of infertile couples have male factors. Fertility is a couple’s problem, and we cannot recommend treating the male without considering female factors too.
Understanding Male Infertility
We offer many treatments for male infertility problems ourselves. We also refer and collaborate with specialty trained urologists.
We offer advanced sperm tests such as the acrosome reaction test to figure out sperm function before treatment.
We offer sperm aspiration procedures for men with blocked tubes such as after vasectomy.
FAQ's
The initial male infertility evaluation starts with a medical and reproductive history and 1-2 semen analyses. Some men with poor sperm will fertilize eggs normally and some men with normal sperm fertilize eggs poorly. What other testing should a man have? Men with a sperm concentration < 10 million/ml should have hormone testing. Men with a sperm concentration < 5 million/ml, should have genetic testing. Poma Fertility offers “advanced sperm function tests” for borderline or abnormal semen. The tests are a) hyaluronan binding assay (HBA), b) the acrosome reaction (AR) test, and c) a 24-hour sperm survival test. Failure to pass these tests suggests the man needs IVF with sperm injection (intracytoplasmic sperm injection, ICSI).
What male factors can cause infertility?
Common problems causing infertility include varicocele, vas deferens obstruction, and medications.
Varicocele: A varicocele is an abnormal dilation of veins within the scrotum detected on physical examination. Varicocele commonly occurs on the left, but it can occur on both sides. Varicocele can cause discomfort. We recommend varicocele correction if a man is infertile, has an abnormal semen analysis, and there no or mild female infertility. Most men with a varicocele are not infertile.
Obstruction: Vas deferens obstruction causes male infertility. The most common reason is vasectomy, but other causes include trauma or infection. Surgery or Testicular Sperm Aspiration (TESA) recovers sperm for natural conception or IVF-ICSI. Men with non-obstructive azoospermia require surgical exploration for testicular sperm.
Medications: Medications may cause infertility. Sometimes, simply stopping the medication allows the man and his partner to have a pregnancy. Common medications causing infertility include testosterone (or other androgens) and chemotherapy (for cancer). Both medications cause infertility by suppressing sperm production. Most men who stop testosterone recover sperm production. Chemotherapy damage depends on the amount and chemotherapy drug. Some of these men recover sperm production over months to years. Oncologists recommend sperm freezing before chemotherapy for selected men.
Other causes for male infertility?
Occasionally, male infertility results from hormone abnormalities or ejaculation problems. These causes are less common but may be treatable. We usually refer these men to a urologist or medical endocrinologist for specialized testing and treatment.
Underlying genetic disorders cause infertility. Men with genetic problems require genetic counseling to determine whether they would pass the genetic condition to their children. Y-chromosome microdeletions, for example, may predict no sperm production. Lifestyle causes include alcohol and recreational drugs. Excessive exposure of the testicles to heat such as hot-tubs, hot baths and sauna use may lead to poor semen quality. Eliminating these stressors often improves semen quality and fertility.
How can we treat or correct male infertility?
The treatment depends on the cause. Lifestyle changes are inexpensive but may be challenging to change. Medical therapy corrects the uncommon case of hormonal dysfunction. Surgery corrects varicoceles and vasectomy obstruction as well as retrieving sperm for non-obstructive azoospermia. IUI benefits some men with mild sperm factors. IVF-ICSI corrects abnormal sperm function (failed fertilization).
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