Male Factor Infertility
The world of infertility is riddled with falsehoods and unclear information. One myth that needs to be clarified is the one that gives the impression that infertility is the woman’s problem and when that problem is fixed, the couple can then conceive. In reality, approximately 30-40% of infertility cases is due to a male factor. It is estimated that as many as two out of five couples with problems in conceiving will require that both spouses seek treatment.
The diagnosis of male factor infertility and undertaking treatment is a complex process. Oftentimes, the cause of male infertility is not known, although there are some areas which show probable causes. These factors include sperm production, (sperm count and motility), anatomy and structure of male organs, or the immune system. Sperm production can be limited due to infection, trauma to the testes, hormonal imbalance, genetic defect, exposure to radiation or certain medications. Infertility can happen when sperm count is low, with problems with the movement (motility) or appearance or shape (morphology) of the sperm. Sperm cannot actually travel to the egg, thus fertilization can not happen or the sperm can get there, but are not able to get inside and fertilize the egg. Sperm DNA damage hinders conception and leads to a greater risk of miscarriage.
Anatomical/structural problems can block the route that sperm must travel to reach the egg for fertilization, causing male infertility. This can be due to scar tissue, varicose veins or infection, or it could be inherited and existing from birth. Some men have immune system disorders causing their bodies to develop antibodies to their own sperm, which attack and weaken the sperm.
A varicocele is one of the most common causes of abnormal male sperm levels. This is a knot of swollen veins surrounding the testicle. Surgery can correct varicoceles and may improve sperm quality and semen analysis results, restoring fertility in approximately two-thirds of cases.
Fixing Male Infertility
Lack of sperm in the ejaculate is a factor in some men. Surgical alternatives for sperm retrieval are looked at with advanced sperm retrieval techniques. These include the following procedures:
1. Testicular biopsy. This is a surgical procedure that can be done in the physicians’ office. In this procedure, many small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures.
2. Testicular sperm aspiration. TESA is a procedure which involves getting a sample of tissue from the testis via a needle biopsy of the testicle. This procedure is done to extract sperm for IVF or ICSI.
3. Percutaneous sperm aspiration. PESA is a procedure which involves aspirating a pocket of sperm. This is done by placing a needle into the epididymis.
4. Testicular microdissection involves careful surgical intervention in the testicle to find any areas of potentially active spermatogenesis. This allows minimal removal of testicular tissue which minimizes the risk of permanent damage to the testicles.
Less than 10 years ago, treatment for a male factor infertility was limited to inseminations or IVF using donor sperm. Advances in male infertility have introduced ground-breaking beneficial choices that offer men, including those with no sperm in their ejaculate, a significantly superior chance to create their own child.