What is Male Infertility?

  • Santa Monica Fertility
  • IVF

Of all infertility cases, nearly half are the result of female factor infertility, and half are the result of male factor infertility. Male infertility may include a range of issues such as: abnormal sperm, low sperm count, genetically mutated sperm, a complete absence of sperm, or sexual dysfunction.

Video Transcript →

In general, infertility is due to male factors one third of the time, female factors one third of the time and both one third of the time, so men really represent half of overall infertility cases. When we check for male infertility we look at the semen analysis, and that comprises sperm count, motility – that’s how they are swimming and how they are shaped that’s called morphology. If a man has a normal semen analysis, he is probably fertile, but not in all cases. My advice to most men is to live a healthy life meaning eat a normal diet, stay within ideal body weight be moderate in alcohol intake, not smoke and not surround the genital area with prolonged heat exposure such as long distance bike riding.

The use of a male formula vitamin with high amounts of anti-oxidants are also very helpful in maintaining sperm health. One of the biggest no-no’s though is testosterone. Testosterone is basically a contraceptive, if a man takes testosterone he is wiping out his sperm and unfortunately that’s not commonly known. All men with a significantly abnormal semen analysis really should have an evaluation by a urologist to make sure they don’t have other health issues that need to be treated. Some of those causes can be quite serious such as genetic problems, tumors, endocrinal hormonal problems.

For men who have moderate abnormalities on their semen analysis we can improve their chances by doing intra-uterine inseminations called IUI also known as artificial insemination. We basically take the semen and wash it and get the best swimmers the A team out and then we introduce those swimmers into the partner’s uterus using a soft guide at the right time of the month.

When men have very severe semen analysis abnormality such as very low count or very low motility we can actually take the sperm and inject it directly into the egg, it’s called the intra-cytoplasmic sperm injection which is known as ICSI. Many men have become fathers because of this revolutionary procedure. It is safe and very effective in fertilizing eggs.

Men who have had a vasectomy and want to have more children can either have a vasectomy reversal or have the sperm harvested directly from the testicle or the holding tank near the testicle called the epididymis and that’s because vasectomy is a procedure where the ejaculatory duct is blocked surgically.

When it comes to the male partner infertility, we have had a long history of overlooking the real impact that men may have on conception and babies. For many years we have trusted the semen analysis as our gauge of male infertility. In fact it is not as reliable as we thought it was. Ten years ago we started looking inside the sperm at the DNA and seeing if the DNA was fragmented and broken up. Turns out that fragmented DNA if in high percentage can impact pregnancy and it can impact embryo development and the chance of pregnancy and even miscarriage. Treatment with anti-oxidants and vitamins actually has shown to be helpful in such conditions.

More recently as the exciting area of epigenetics a phenomena where men through their lifestyle and medical condition put molecules on the DNA of sperm. And those molecules can influence how the genes of sperm work and can impact embryo development early pregnancy loss and even trans generationally children, grandchildren and great grandchildren. So what a man eats, his medical conditions, his lifestyle choices really can impact the outcome of a pregnancy now and for future generations.

So we are now opening up this very exciting era in understanding male fertility and I think we are going to improve the outcomes of pregnancy by improving our assessment of sperm and modifying that man’s health as it comes to sperm.

Male fertility is evaluated with the use of the semen analysis. This test primarily evaluates the semen for sperm count, motility (how they swim) and morphology (how the sperm are shaped). Men with semen analysis abnormalities should be evaluated by a qualified practitioner as it may be the sign of other health problems.

Once evaluated, male infertility may be treatable depending on the severity of the infertility. Sperm quality may be improved by lifestyle changes such as limiting time in hot baths and alcohol intake or by discontinuing certain drugs (testosterone) or supplements.

To treat mild semen abnormalities intra-uterine insemination, or “IUI,” can be used to concentrate the best sperm for injection directly into the uterine cavity. Additionally, a procedure called intra-cytoplasmic sperm injection (ICSI) is sometimes used to inject healthy sperm directly into eggs to enhance fertilization.

For men who have an absence of sperm completely, or have undergone a vasectomy, it is sometimes possible to surgically retrieve sperm from the epididymis (where sperm are stored before ejaculation) or a biopsy of the testes can yield functioning sperm.

Men with sexual dysfunction, such as erectile dysfunction, can often be treated through prescription medication.

Sperm donation is sometimes the final option for men who do not produce any sperm or for those with genetically abnormal sperm.

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