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The Male Factor
In about 40% of infertile couples, the male partner is the sole or a contributing cause of infertility. A semen analysis is important in the initial evaluation. To prepare for a semen analysis, you will be asked to abstain from ejaculating for at least 48 hours. The male patient then will collect a semen sample in a cup by masturbating at home or in the physician’s office. In some instances, a semen sample may be obtained during sexual intercourse using a special condom provided by the physician.
The semen specimen is examined by microscope to determine the volume, motility, and morphology of the sperm. Sometimes two or three semen analyses are required over two to six months, as sperm quality can vary over time. Other hormonal or genetic tests may be recommended as well, depending on the type and severity of abnormalities found.
If the semen analysis reveals abnormalities, he may need to consult a clinician who specializes in male infertility. Treatment for male factor infertility may include antibiotic therapy for infection, surgical correction of varicocele or duct obstruction, or medications to improve sperm production. In some men, surgery to obtain sperm from the testis can be performed. In some cases, no obvious cause of poor sperm quality can be found. Intrauterine insemination (IUI) or IVF may then be recommended. Direct injection of a single sperm into an egg (ICSI) may be recommended as a part of the IVF process.
If no sperm are present on semen analysis or not found at surgical extraction, your physician may discuss using a sperm donor. Insemination with donor sperm may also be considered if IUI is not successful or if you and your partner do not choose to undergo IVF.