Male-factor infertility accounts for 30-40% of all infertility issues. A semen analysis is an easy, non-invasive test that should be an early part of the evaluation for heterosexual couples. We look at the following parameters for a semen analysis:
- Volume: Normal semen volume is 1.5ml or more.
- Concentration: Normal sperm concentration is greater than or equal to 15 million per ml of semen.
- Motility: At least 50 percent of sperm should be motile and moving forward. The sperm motility indicates how successful the sperm may be at passing through the cervical mucus and through the uterus and fallopian tube to finally reach the egg.
- Morphology: Using strict (Kruger) criteria, normal semen has at least 4% of sperm with perfect morphology. Morphology scores of 2%-3% are subnormal but can still lead to pregnancy without requiring IVF. Morphology scores of 0-1% are more worrisome and may ultimately require IVF/ICSI.
- Progression: The ability of sperm to move forward. A sperm progression score of 3 or higher is considered normal.
The medical history of the male may suggest certain lifestyle factors that could be modified to improve the sperm quality/quantity. These include cessation of smoking, eating a healthy diet, and avoidance of heat. Men who are actively trying to conceive should limit their use of saunas, hot tubs, whirlpools, and soaking baths.
The approach to the male patient will depend on the severity of the problem, the age of his female partner, and the type of treatment they are willing to undergo as a couple. Consultation with a urologist (male fertility specialist) may be offered if the male wishes to conceive as naturally as possible.
Male Infertility Treatment
Male infertility cannot usually be treated effectively with fertility drugs. In rare cases the male can be treated with medications such as Clomid. These treatments can take several months to be effective. For mild problems, intra-uterine insemination (IUI) (a.k.a. artificial insemination) is often the first line therapy. This can be combined with ovulation induction medications for the female to increase the number of mature eggs produced for that cycle. Most couples undergo 3-6 cycles with IUI before moving on to IVF if necessary.
Moderate to severe male infertility can be treated using intracytoplasmic sperm injection (ICSI), an advanced IVF laboratory technique. ICSI is performed as a part of the IVF cycle. In ICSI, a single sperm, which is collected by masturbation or biopsy, is injected directly into the egg. ICSI makes it possible for a man to father a child even though there may be no sperm in the ejaculate. Sperm can be obtained directly from the reproductive tract using testicular sperm extraction (TESE), testicular sperm aspiration (TESA) or microsurgical epididymal sperm aspiration (MESA). These advanced techniques would be performed by a urologist that specializes in male infertility. ICSI can also be used when a couple has experienced failed fertilization in a previous IVF cycle.