There are multiple causes of infertility. The three most frequent individual
causes are abnormalities of ovulation, abnormalities of the fallopian
tubes, and male factors. These three causes account for some 80% of infertility
cases, with male factors accounting for 20-35% of these cases. Male infertility
testing should be one of the very first tests carried out in the diagnostic
process of the couple experiencing infertility.
At ACRM, we work with several Board certified urologists specializing in
male fertility throughout the Atlanta area. We offer several treatments
for male infertility so that you and your partner can explore all the options.
Treatment of Male Factor Infertility
The type of treatment used will depend directly on how many good quality
sperm are available. In situations where sperm numbers are low but close
to normal, the option of Intrauterine Insemination (IUI) is available.
In situations where sperm numbers are markedly reduced, the best option
is ICSI during a cycle of in vitro fertilization. Although the option
of insemination using donor sperm is always available, its usage has decreased
dramatically as ICSI has allowed many more men to use their own sperm
to create a successful pregnancy.
How to Treat Male Factor Infertility
The treatment of male factor infertility is dependent on patient’s
specific condition. Sexual dysfunction, for example, is often treated
by infertility counseling rather than by "medical" therapies.
Most commonly, however, we will be treating male factor infertility with
therapies such as inseminations or In Vitro Fertilization. We begin the
evaluation with a semen analysis. If the count, motility, or shape of
the sperm are consistently low, blood work for hormonal status and genetic
abnormalities begins.
In order for fertilization an pregnancy to take place, a minimum number
of sperm must "find" the egg. When everything is normal, fertilization
will take place in the fallopian tube. The fallopian tube is a complex
organ that twists and turns, which can make it difficult for the sperm
to find the egg. Once the sperm finds the egg, they will begin breaking
through the layers of cells and protein that surround the egg before the
final step of fertilization can take place. This is a difficult task,
which is why millions of sperm are released during ejaculation in order
to increase chances of pregnancy. Treatment for male factor infertility
will depend on how many healthy sperm are produced and released by the patient.
What Is IUI (Intrauterine Insemination)?
In normal situations at least 50 million sperm are ejaculated into the
vagina during intercourse. Of these, only 5-10 million will make it out
of the vagina into the uterine cavity. It has been shown that we can easily
place sperm directly into the uterine cavity by means of an intrauterine
insemination wherein a small flexible catheter is passed through the cervical
canal into the uterus, and the sperm can then be injected through that
catheter. In order for intrauterine insemination (IUI) to be successful,
as a general rule, roughly 3 million healthy, motile sperm must be available.
The IUI Procedure
The procedure of IUI is very straightforward. The male partner will produce
a specimen, which is then processed in the laboratory. From here, our
technicians will remove the sperm cells from the semen and concentrate
the healthiest sperm into the droplet of culture media which will then
be placed into the uterus.
Processing of a sperm specimen will typically take 1-2 hours depending
on the method used. The actual IUI is done in the office and is similar
to a routine pap smear. Using a speculum to see the opening of the cervical
canal, a thin flexible plastic catheter can be introduced into the uterine
cavity. Once in place, the sperm containing droplet is injected through
the catheter. Most women do not feel this at all, some however may experience
a slight cramp when the catheter enters the uterine cavity.
IUI Success
Although we usually must have 3-5 million sperm available for IUI success,
there are always exceptions to this. Occasionally we will see a pregnancy
from an insemination where only a few hundred thousand sperm were available.
Nonetheless, if less than 3 million sperm are present the success rates
are low, and it would be in your best interests to explore alternative
treatments. If a couple has less than 3 million sperm available, it is
appropriate to move on to more aggressive therapies.
Donor Sperm
Using donor sperm may be an option for couples who are dealing with severe
cases of male factor infertility. The use of donor sperm is a straightforward
process: we identify the ideal time for insemination and schedule a date
for your appointment. Success rates are excellent and the process is more
affordable that repeatedly attempting procedures that have low chances
of success.
What Is ICSI (Intracytoplasmic Sperm Injection)?
Intracytoplasmic Sperm Injection (ICSI) is a technique that involves injecting
a single sperm into the egg at the time of in vitro fertilization. This
technology has revolutionized the treatment of male factor infertility.
Now, as long as the husband has sperm, pregnancy is possible. ICSI has
been used successfully in situations where the husband has extremely low
counts, and even in situations where there are no sperm in the ejaculate
although there may be sperm production in the testis.
Men who pay benefit from ICSI include those:
Who had unsuccessful reversals of vasectomies
Who are born without the vas deferens
Who have abnormal development of sperm
The reproductive health of the female partner is an important determining
factor when figuring out if ICSI is a viable option. ICSI requires the
couple to undergo in vitro fertilization and allows men to establish pregnancies
who previously would never have been able to do so.
