Male Infertility

Male infertility is now recognized as a major and increasing contributing cause to many couples suffering from infertility.

Male Fertility Treatments

Male fertility requires that an adequate amount of “quality” sperm is ejaculated into the vagina and capable of swimming through the cervix, into the uterus and to the fallopian tubes. 

A sperm must attach to, and penetrate, the zona pellucida (membrane surrounding the egg) and fertilize the egg.

Causes of Male Infertility
Causes of male infertility may include: abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or previous trauma. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.

There are very few cases where fertility drugs are effective in treating sperm and/or semen abnormalities. Moderate to severe male infertility can often be treated with in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), where a single sperm can be directly injected into the egg. When antisperm antibodies are present, IUI may be the first line treatment since the procedure avoids the cervical mucus where the antibodies reside.

The Semen Analysis

A semen analysis is the first step in evaluating the male factor for couples undergoing an infertility evaluation, and contains several important pieces of data to evaluate: volume, count, motility (ability to swim) and morphology (size and shape).
  • Volume. This measures the total volume of the ejaculate. While normal values are given on the report, there are no known causes of infertility associated with abnormal semen volume.
  • Count. The sperm count is given in concentration (sperm/ml) and total count. Low sperm counts are usually assumed to be related to infertility
  • Motility. This is usually expressed as a percentage of moving sperm. Generally speaking, 10 million sperm with good motility per ml is acceptable.
  • Morphology. Normally shaped sperm.

Men with an abnormal semen analysis should consult with a reproductive endocrinologist. A urology consult may be indicated in some cases. Most men with an abnormal semen analysis can father children with appropriate treatment.

Intracytoplasmic Sperm Injection (ICSI)

A specialized form of in vitro fertilization (IVF) used primarily for the treatment of severe cases of male infertility.

ICSI is a lab procedure where a single sperm is picked with a fine glass needle and is injected directly into each egg. Very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this has been assisted by the ICSI technique.

​ICSI is recommended for couples who have had poor or no fertilization during standard IVF, as well as men who have:

  • Poor sperm morphology (abnormally shaped sperm)
  • Poor sperm motility (slow moving)
  • A low sperm count
  • An obstruction such as a vasectomy, which prevents sperm release
  • Antisperm antibodies (antibodies that are produced by the man’s body and may inhibit sperm function)
  • A vasectomy reversal that was unsuccessful or resulted in a low sperm count or poor quality sperm

As ICSI is more invasive and requires more handling than standard IVF insemination techniques, there is a very small chance (less than two percent) that the egg may be damaged during the procedure – resulting in a non-viable egg.

Treatment Options

There are a variety of treatment options for male infertility, including:

  • ICSI – intracytoplasmic sperm injection, with IVF, where a single sperm can be directly injected into the egg. ICSI can be used in conjunction with TESA, MESA and PESA noted below
  • TESA – Testicular Sperm Aspiration
  • MESA – Microsurgical Epididymal Sperm Aspiration
  • PESA – Percutaneous Epididymal Sperm Aspiration
  • IUI – Intrauterine Insemination is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. IUI provides the sperm an advantage by giving it a head start but still requires a sperm to reach and fertilize the egg on its own. It is a less invasive and less expensive option compared to
  • Sperm donor – Donor sperm can be used with IVF or IUI. If you are using a sperm donor with your IVF procedure, you will still administer fertility medications to prepare your eggs for retrieval.

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