Male Infertility

Male Infertility Causes and Male Infertility Treatments

man treated for male infertilityMale infertility refers to the inability of a male to contribute to conception with a fertile female. The good news: with modern treatment tools, in a large majority of cases, affected males can become fathers.

Among couples with infertility, approximately 55% have a female problem, about 45% have a male factor problem and a full quarter (25%) have issues on both sides. The ability to treat female and male infertility in parallel is, therefore, crucial for modern infertility care.

Whatever the severity of male infertility, CHR has the knowledge and experience to help at least 90% of affected males to become the genetic fathers of their children. Furthermore, with our special expertise in complex cases of female infertility, including premature ovarian aging and diminished ovarian reserve, CHR is a one-stop infertility center for female as well as male infertility.

Male Infertility Diagnosis

Initial diagnosis of male infertility primarily relies on one or more rounds of semen analysis. In a semen analysis, three parameters are evaluated:

Parameters
Normal Findings
  • Semen motility (how well the sperm moves)
At least 50% of sperm should "swim" in more or less straight line. Sperm that "moves" well is more likely to reach the egg.
  • Morphology (how the sperm's head looks in appearance
At least 15% of your sperm should have a normal shape and structure, with an oval-shaped head. Abnormally shaped sperm is less likely to be able to fertilize an egg.
  • Sperm count (the number of sperm in a milliliter os semen)
Sperm count should be above 20 million in a milliliter of sperm. Complete semen sample should have at least 40 million sperm.

While a semen analysis is the basis for a diagnosis of male infertility, the truth is that any of these semen analysis parameters, in isolation, does not mean much. What a male fertility specialist tries to determine, through semen analysis, is how normal or abnormal the sperm "functions."

Biologically speaking, sperm has practically only one function: the fertilization of the egg. We do not have tools to directly test for this ability, because, for obvious ethical reasons, we cannot test sperm against human eggs to see whether a sperm is capable of fertilizing them. Therefore, we do the next best thing, which is the semen analysis. If a semen analysis is normal in all three parameters, there is a 99% likelihood that the sperm's function is also normal. If one or more parameters are abnormal, for example, abnormally low sperm count is discovered, one can assume a fertilization problem exists in proportion to the severity of observed abnormalities in the semen analysis.

Male Infertility Causes

There are a number of causes for male infertility, all affecting quantity and/or quality of sperm.

  • The sperm's exit route is blocked (from birth, by scarring from infection, past vasectomy, etc.)
  • Retrograde ejaculate (semen is ejaculated backwards, into the bladder)
  • Sperm production in the testes is low or absent (there can be many causes for this finding)

Male Infertility Treatments

Treatment approaches for male infertility varies greatly, depending on the severity of the sperm problem. In mild cases, artificial insemination (or intrauterine insemination, IUI) may be enough. In an IUI for male infertility, semen sample is prepared and concentrated in the laboratory before injection into the uterus.

In more severe cases, in vitro fertilization (IVF) may be the best option. IVF for male infertility allows performance of intracytoplasmic sperm injection (ICSI), which virtually guarantees fertilization, even with very poor sperm (for further detail, see below).

In most severe cases of male infertility (so-called azoospermia, meaning complete absence of sperm), we are successful in retrieving very small amounts of sperm from the man's testicles themselves, in approximately 85% of cases. At CHR, this procedure is performed by highly specialized urology colleagues with special expertise in these procedures. The small amounts of sperm obtained either by testicular sperm extraction (TESE) or testicular biopsy, can then be used in ICSI to fertilize the woman's eggs in an IVF cycle.

ICSI for Male Infertility

ICSI is a microsurgical procedure, in which an embryologist selects the best sperm from a prepared sample and injects it directly into an egg. This micromanipulation of eggs and sperm ensures the mechanical fertilization of one egg by one sperm. ICSI has revolutionized the treatment of male infertility, making it possible for a vast majority of males, even with very severe male factor infertility, to become genetic fathers of their children.

In the picture on the right, the egg is held in place with a micro-pipet while an embryologist inserts a tiny needle containing a sperm into the egg. The sperm is released into the egg for fertilization.

Surgery for Male Infertility?

Some of our urology colleagues at times recommend (micro-)surgery to treat male infertility due to structural problems. The two most common indications for surgical treatments are the presence of so-called varicoceles and obstruction of semen outflow due to an earlier vasectomy.

Varicoceles are dilated veins in the scrotum, which may raise the temperature inside the scrotum, and affects sperm production negatively. In a surgical approach to varicoceles, these dilated veins are ligated. In a vasectomy reversal, a surgical approach to past vasectomy, the surgeon tries to reconnect interrupted duct (vas deference) that carries sperm from the testes.

Our urology colleagues sometimes disagree with us, the fertility specialists, about when these surgeries may be the best option. Vasectomy reversals, in our opinion, are effective in only half of all cases at best. While some urology colleagues claim higher success rates, we actually have doubts about even this 50 percent number. We are even more skeptical about varicocelectomies. At our fertility center, we very rarely see a varicocelectomy turning an infertile male into a fertile male, who no longer needs IVF+ICSI to father a child. Most men, unfortunately, even after varicocelectomy, still need IVF+ICSI to do so.

And that is the principal reason why we, on occasion, disagree with our urology colleagues on when to perform surgery for male infertility. For our urology colleagues, the question is whether surgeries improve the sperm parameters of the male. If they do achieve a better sperm analysis by doing surgery, they consider this a success. However, for us, the fertility specialists, improvement in semen analysis parameters is simply not enough. For us, a successful male infertility surgery is one that converts a couple from needing IVF+ICSI to being able to conceive spontaneously, on their own. Unfortunately, the number of surgeries that do this in cases of male infertility is rather small.

Male Infertility Treatments at CHR: Benefits of a Comprehensive Approach

As stated above, given the proportion of infertile couples with issues on both male and female, the ability to treat female and male infertility in parallel is essential for modern infertility care.

Whatever the severity of male infertility, CHR has the knowledge and experience to help at least 90% of affected males to become the genetic fathers of their children. Furthermore, with our special expertise in complex cases of female infertility, including premature ovarian aging and diminished ovarian reserve, CHR is a one-stop infertility center for female as well as male infertility.

Contact Us about Male Infertility Diagnosis & Treatment

CHR is an expert resource on the subject of male infertility diagnosis and treatment. Please contact us if you have any questions or want to know more about our male infertility treatments.

Last Updated: January 28, 2013