Male Infertility
Male Infertility Causes and Male Infertility TreatmentsMale 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 DiagnosisInitial diagnosis of male infertility primarily relies on one or more rounds of semen analysis. In a semen analysis, three parameters are evaluated:
ParametersNormal Findings
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.
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 DiagnosisInitial diagnosis of male infertility primarily relies on one or more rounds of semen analysis. In a semen analysis, three parameters are evaluated:
ParametersNormal Findings
- Semen motility (how well the sperm moves)
- Morphology (how the sperm's head looks in appearance
- Sperm count (the number of sperm in a milliliter os semen)
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 CausesThere 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 TreatmentsTreatment 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) ortesticular biopsy, can then be used in ICSI to fertilize the woman's eggs in an IVF cycle.
ICSI for Male InfertilityICSI 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 below, 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.
