 Male Infertility
Infertility is caused by a male factor in
approximately 20%-30% of cases. An additional 20% of couples are found to have a
combination of male and female factors contributing to their infertility.
About three quarters of cases of male
infertility are related to either low sperm count, poor motility (ie: the number of
sperm which are viable and moving), or abnormal morphology (ie: malformed
sperm). While there are many theories about what causes these conditions, in
most cases it is not possible for the fertility specialist to identify the cause.
The remaining one-quarter of male
infertility results from obstructions in the testes, hormonal failure, or auto-immune
factors.
Unlike female infertility, which requires a
battery of tests to diagnose, male infertility requires only a semen analysis. If it
is normal, no other testing of the male partner is required.
Of course, the couple should ensure that
the laboratory performing the semen analysis is highly experienced in this procedure and
that they check the motility and morphology as well as the count.
If the semen analysis shows that there is a
problem, then other tests are required in order to try to pinpoint the cause. These
can include a physical exam by a urologist - ideally one who specializes in infertility -
and some blood tests.
Many tools are available to the fertility
specialist for treating male infertility.
In mild cases, super-ovulation with
IUI (a procedure in which the wife is given fertility drugs to stimulate formation of
multiple eggs, thus increasing the possibility that any one will fertilize, then injecting
the husband's semen directly into her uterus) can be utilized.
When auto-immune factors are present, the
sperm are first purified in a technique called "sperm washing."
In Vitro Fertilization (IVF) is also
frequently used for male factor infertility.
Recently, two high-tech breakthroughs have
increased the odds significantly for couples with severe male infertility undergoing
IVF:
Utilizing "ICSI" (pronounced "icksy"), which stands
for Intracytoplasmic Sperm Injection, a single sperm is all that is needed. It can
be injected, using microscopic techniques, directly into an egg. In this procedure,
the wife undergoes a normal IVF cycle. However, when it is time to fertilize the egg, a
single sperm is drawn into a very thin-tipped pipette. The tip of the pipette is
inserted into the egg and the sperm is then released directly into the egg.
This process can be repeated for each egg.
Or, if a man has no sperm whatsoever in the ejaculate, it is now possible
to remove a few sperm cells directly from testicular tissue, utilizing a procedure called
"TESA" (Testicular Sperm Aspiration). These cells can then be injected into an
egg using the ICSI procedure described above.
For couple who do not want to undergo IVF, artificial insemination by
donor (AID) can be used. Modern sperm banks use very careful screening procedures
before accepting a man as a donor. The couple never meets the donor or knows his
identity, but they are provided with a description and medical history. AID has been
used for many years by fertility specialists with much success.
More detailed information
on male infertility is available online from | 
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