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Male Infertility This is a condition that by itself affects up to 40% of couples facing infertility problems. An additional 20% of infertile couples have combined male-female factor infertility. These figures suggest that the relative incidence of male related infertility problems may be approximately the same as female problems. Diagnosis The most significant element when dealing with male-factor infertility is to establish the correct diagnosis. We cooperate with your urologist and will assist him through our Andrology Laboratory to reach the appropriate diagnosis of your condition. Some infertility problems are just a manifestation of more severe medical conditions that if not diagnosed properly may become life threatening or may affect the offspring. We seek to help you overcome your infertility problem by offering alternatives that might eventually lead to the birth of a baby. However, we do not treat the causal factors of infertility that the urologist traditionally treats. Once the cause of male infertility has been diagnosed, the Infertility & IVF Center can help you with a range of seminal tests and evaluations from semen analysis to other specialized sperm function testing. These include hemizona assay, sperm antibody and leukocyte quantitation, in-vitro cervical mucus penetration test, acrosome reaction, SCSA, and sperm overnight culture. Also, we have the capability to freeze your sperm (sperm banking) if it is necessary. The information generated from the quantitative and functional tests performed at the Infertility & IVF Center is utilized by our staff to implement an individualized infertility treatment. The objective of our treatment is to help you and your partner achieve pregnancy. Depending on the severity of the male factor infertility and on the medical history of your partner we may suggest you utilize the least invasive modalities for infertility such as intrauterine inseminations (IUI), or In-Vitro Fertilization if the counts of motile sperm are such that a series of IUIs may not be effective. Usually these treatments require that the male partner should be able to provide at least two (for IVF) or five (for IUI) million motile sperm. If the sperm counts are below the above limits, there is still the option for sperm banking to overcome this problem. Donor semen is also available. ICSI, the answer for male factor infertility The spermatozoa collected are used to fertilize mature oocytes. Since a low number of spermatozoa may be obtained, the oocytes are fertilized by Intra Cytoplasmic Sperm Injection (ICSI). This procedure optimizes the sperm number since only one motile sperm cell is required per oocyte. Without this method the probability of fertilization and pregnancy for such men is less than 1%. However, when PESA or TESA and ICSI are combined, the probability of fertilization and pregnancy reaches values similar to those observed in conventional IVF. Treating the most severe cases of male infertility with ICSI There is a population of patients that may not be able to benefit from IUI or conventional IVF due to inadequate numbers of sperm or fertilizing functional ability of sperm. In the past, the only alternative for patients under this classification was to use donor sperm or to consider adoption. In recent years, a procedure called Intra-Cytoplasmic Sperm Injection (ICSI), which consists of the direct injection of a single sperm into an egg, has been perfected. ICSI enhances the probability of achieving pregnancy in even the most difficult of male infertility cases. When to utilize ICSI Moderate cases of male factor infertility may be successfully treated by conventional IVF treatment. However, ICSI now offers a new dimension of treatment for all more severe forms of male infertility. ICSI may be indicated when: 1. Patients present low sperm density, motility, poor morphology, sperm antibodies or low scores in functional bioassay. 2. Cases with less than 50% fertilization or total fertilization failure in previous IVF attempts. 3. For azoospermia or lack of spermatozoa in the ejaculate when sperm aspiration is necessary. Azoospermia may just be a symptom of deeper medical conditions. Therefore, proper identification of these conditions is of major clinical relevance. The four main causes of azoospermia will be discussed in Male Factor Offspring. Male Factor Infertility and Your Offspring In cases such as Acquired Obstructive Azoospermia (vasectomy, failed vasectomy reversal, inflammatory lesions due to infection) or Inability to Ejaculate (spinal cord injuries, surgery, psychological causes or retrograde ejaculation) no major effects on the offspring over naturally occurring rates should be expected. However, in other conditions such as Congenital Absence of the Vas-Deferens or Testicular Insufficiency (low sperm counts and motility) additional tests may be indicated to rule out the presence of other problems that may affect your offspring. Note that there are many more genetic abnormalities associated with male infertility, than in the female. |
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