|
Male infertility is present in up to half of all infertile couples. Infertility was once thought to be a “female problem”. We know that almost half of all infertile couples have some degree of male infertility. Male infertility findings vary from low sperm count, subtle abnormalities in shape and movement, to complete absence of sperm. Unlike females, “normally fertile” males remain fertile for their entire adult life.
Sperm require three months to develop and a semen analysis done today reflects conditions three months ago. One of the more common causes of male infertility is abnormal temperature increases in the testicles. The scrotum performs a cooling/warming function for the testicles. When the temperature is too high the scrotum expands moving the testicle away from the body and thus lowering their temperature. When the temperature is too cool, the scrotum contracts bringing the testicles closer too the body.
Male infertility (varying degrees) can result when tight clothing or occupation interfere with the scrotal temperature regulation function Occupations such as a long distance truck driver can cause the scrotum to remain close to the body thus interfering with the cooling function. Other causes of male infertility include habitual, long term exposure to elevated temperatures such as occurs when regularly “soaking” in a hot tub.
Male infertility can also result from a varicocele, which is a “blockage” of the veins in the spermatic cord. These veins serve a temperature regulation function by circulating blood from the testicles thus causing cooling and heating. A urologist can often surgically correct a varicocele.
Male infertility can also result from male or female antisperm antibodies. Antibodies mistake sperm for harmful pathogens and seek to destroy them. Rarely, a man produces antisperm antibodies to his own sperm. More commonly the female produces antisperm antibodies. In males, antisperm antibodies usually occur when there has been some type of “blood exposure” as in testicular trauma.
When antisperm antibodies are present in the female’s cervical mucus, intrauterine insemination (IUI) is often the treatment of choice. In IUI, the sperm are placed directly into the uterus using a catheter, thus avoiding the antibodies in the cervical mucus.
Male infertility can result when sperm are negatively impacted by environmental factors such as work related exposure to heavy metals. Smoking has been shown to reduce sperm count.
“Medical” causes of male infertility are rare and usually result from severe deficiencies of FSH and LH. While the fertility drug Clomid or FSH can sometimes improve sperm parameters, the treatment requires at least three months and improvements are marginal.
 In the past, when severe blockages or medical abnormalities were present the only option for couples was to use a sperm donor. While many still choose a donor, new technologies enable men with few, or no, sperm in their ejaculate to create genetically related children. Using in vitro fertilization with ICSI, a single sperm is injected directly into the egg. If a sperm cannot be obtained from the ejaculate, it can often be withdrawn surgically directly from the testicle (TESA) or the reproductive tract (MESA).
Oftentimes men seek reversal of a previous vasectomy. While reversal is sometimes possible depending upon where and how the tubes were "cut", a vasectomy should be considered a permanent means of birth control. In vitro fertilization usually produces higher per cycle success rates than vasectomy reversal.
Given today’s incidence of divorce and remarriage, the decision to have a vasectomy should never be taken lightly, especially in younger men.
Male Infertility- An Outline of Male Infertility Facts
- Male factor infertility is present in up to 40% of infertile couples
- New sperm are produced every 72 days so different diseases and toxins and vitamin deficiencies present then, can effect the sperm today.
- A detailed history of the male partner is important. The frequency of sexual intercourse, erectile dysfunction, medications, and smoking are a few of the factors that can decrease sperm count and increase the number of abnormal sperm. Use of lubrications like KY can impair sperm motility.
- Prior surgery like hernia repair, or trauma to the testis, should be considered and investigated.
- Approximately 20% of the time sperm deficiencies are due to endocrine abnormalities, such as low testosterone. Other causes are genetic abnormalities, high prolactin hormone levels, or previous chemotherapy or radiation.
- A varicocele is a dilation of the major veins of the testicle which may increase testicular temperature and lower sperm count leading to male infertility. Repair of a varicocele may improve sperm quality by 50% but improvement may not be seen for 6 months. A varicocele can be detected with scrotal ultrasound.
- Certain medications can be toxic to sperm like narcotics, steroids, heat, alcohol, marijuana (both alcohol and marijuana reduce testosterone), or tobacco use. Prolonged hot tub use can damage sperm.
- Certain infections can impair the sperms’ ability to penetrate an egg leading to infertility. Diseases including diabetes, mumps, and recent fever can also impair sperm.
- Evaluation is by semen analysis after 2-3 days of abstinence. “Normal” sperm parameters include at least 20 million sperm with 50% motility, and normal shape (>14%). If there are less than 5 million sperm, we also evaluate hormones like testosterone, FSH and LH, estradiol, and prolactin. We will do genetic chromosomal testing on men with low sperm counts when indicated.
- Men without sperm in their ejaculate can have an obstruction of the duct leading from the testis, or a problem with testicular production of sperm.
- Certain reactive oxygen species can damage sperm.
- Smoking can increase reactive oxygen species and decrease fertilization by 50%.
- Heavy smokers have increased cadmium toxicity in the testis.
- Zinc modulates cadmium toxicity and improves sperm motility and morphology.
- Vitamin C and E are natural antioxidants and improve sperm motility
and concentration.
- Selenium increases sperm concentration.
- L-Carnitine supports the energy usage of sperm and may work as an antioxidant.
- Protein in the diet is essential for sperm production.
Many forms of male infertility can be treated once the etiology (cause) is known. IUI is performed when the male has more than 10 million sperm and is done by washing the sperm, concentrating it, and placing it inside the uterus using a small catheter.
If there are less than 10 million sperm, we often perform IVF with intracytoplasmic sperm injection (ICSI). ICSI involves injecting a sperm directly into the egg.
We can also extract sperm directly from the testis if there are none in the ejaculate.
Erectile Dysfunction
- Only 10-30% of men seek treatment
- They have poor communication with their partner
- They think it is part of aging
- Most often erectile dysfunction is due to a combination of medical and psychological problems.
Medical Causes of Erectile Dysfunction
- It could be hormonal
- Neurological
- Diabetes mellitus
- Erectile dysfunction is a major risk for heart disease.
- Some medications can cause erectile dysfunction. Blood pressure medications are one example.
Psychological Causes of Erectile Dysfunction
- Depression
- Performance anxiety
- Stress
- Marital problems
- The woman thinks the man is having an affair
- Some women feel there mate is no longer attracted to them
- They don’t want to embarrass him by initiating sex and facing erectile dysfunction.
|
