Male Infertility Evaluation


Infertility or fertility problems commonly only seen as women problem. But do you know that almost 50 percent causes of infertility is also caused by male factors. Because of this reason, it is very important for both husband and wife to conduct the examination. Determine the cause of infertility is not always easy, but infertility in woman usually caused by disorders in reproductive system. While the male is usually caused by low sperm amount or the quality of the sperm.

Here are some of the most common causes of fertility problems in men that are commonly encountered.

» Sperm duct is blocked, either because of physical or congenital disorders can cause sperm can not enter the seminal fluid. Physical trauma to the testes, prostate and urethra can also cause blockage of these channels. In some cases surgery can solve this problem.

» Sexually transmitted infections such as clamidia and gonorhea can cause fertility problems in men.

» Ejaculation disorders. In this condition, semen does not come out through penis during ejaculation, but instead get into bladder. The cause is usually due to diabetes, prostate or bladder surgery, and certain drugs.

» Autoimmune diseases. Hormonal imbalance can also affect male fertility. Abnormalities in the sperm enzyme also causes the sperm hard to penetrate the egg, so the fertilization does not occur.

» Sexual problems such as impotence and premature ejaculation.

» Varicoceles, the enlargement of the veins in scrotum and interfere with blood circulation. Varicoceles are found in 15 percent of men and about 40 percent of causes of infertility in men.

Semen analysis :

This is the main laboratory investigation for the assessment of the male fertility potential. A sample of semen is examined in the laboratory checking several well defined parameters. These parameters together give a reasonably accurate impression of how normal the semen is. However, there has been great difficulty in defining the optimal value of these parameters. This is because some patients with relatively poor semen parameters can still father children provided their partner's fertility potential is high.

A semen sample is produced for analysis by masturbation after two to five days of abstinence from ejaculation. Usually an abstinence period of two to three days is adequate. This period of abstinence is for the purpose of standardization so that result from different men can be compared easily. The ejaculate is collected into sterile plastic containers that non-toxic to spermatozoa. It is recommended that the man washes his hands and genitals with soap, rinses them several times with clean water and dries with a clean towel. No lubricant such as petroleum jelly is allowed during masturbation since most of these lubricants have been shown to be toxic to spermatozoa.

Treatment of Male Infertility :

Treatments for male infertility range from surgical intervention or intrauterine insemination (IUI) to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Depending on the source of the problem, sperm can be taken from the man's ejaculate for use in assisted fertilization procedures.

One treatment option for men who do have sperm in the ejaculate is intrauterine insemination (IUI). Intrauterine insemination is an infertility treatment in which sperm are placed directly into the female's uterine cavity near the time she ovulates. IUIs are commonly performed when there is a low sperm count or low motility. The sperm that will be injected during the procedure are prepared using a process called sperm washing. The sperm are "washed" to remove any extra cells and debris in an effort to obtain the greatest concentration of the highly motile sperm that will be used for the insemination.

One of the most common problems affecting male sperm levels is a varicocele, a tangle of swollen veins surrounding the testicle. Surgical correction of large varicoceles may improve sperm DNA quality and semen analysis results, as well as restore fertility in about two-thirds of cases.

In some cases there is no sperm in the ejaculate so surgical options for sperm retrieval are explored. Advanced sperm retrieval techniques, including TESA, PESA testicular microdissection and testicular biopsy, combined with IVF and ICSI, now allow men with either a low sperm count or no sperm in their ejaculate the chance to produce a child.
» Testicular biopsy - an in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures.

» Testicular sperm aspiration (TESA) - a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI.

» Percutaneous sperm aspiration (PESA) - a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperm.

» Testicular microdissection - involves careful surgical intervention in the testicle to locate any areas of potentially active spermatogenesis. This allows minimal extraction of testicular tissue which minimizes the risk of permanent damage to the testicles.
For some couples, the use of donor sperm remains the best option for building a family. Obviously, donor sperm is the only option for men whose testicular biopsy reveals complete azoospermia - no trace of sperm in the testicular tissue. The use of donor sperm may also be considered when genetic screening indicates a possibility of passing on hereditary conditions such as cystic fibrosis to male offspring.

An increased understanding of male factor infertility and the recent advances made in assisted sperm retrieval techniques are now giving men who never thought they could have biological offspring the chance to father a child.