Male Infertility Evaluation and Treatment
Male-factor infertility alone is responsible for infertility in about 30% of cases, and can contribute to infertility in another 20% of cases. This means that there is some degree of male-factor infertility in up to half of infertility cases.
Male infertility evaluation involves testing whether enough sperm of good quality are being produced and whether it’s getting to where it needs to go to fertilise an egg and produce a pregnancy.
A thorough medical history is a very important part of the male’s workup of infertility. Gathering information about current and past events and conditions can help show what might be contributing to infertility. The various aspects which may be relevant include Fever, Childhood diseases, Undescended testicle, The timing of puberty, Infections, Surgery, Trauma, Sexual history, Exposure to Chemicals /toxins, Drug/Tobacco/Alcohol use, Hot tub/Sauna use, and Respiratory illness.
Once the history is complete, a complete physical exam will be done. This includes checking for the development of secondary sexual characteristics, any signs of hormonal imbalance and examination of male genitalia.
The next step is the semen analysis. This will tell us if there are enough sperm that move and are shaped normally. The morphology of the sperms will point towards its ability to fertilize the ovum. In some men, semen can flow into the bladder. This can be seen by collecting a urine sample immediately after ejaculation for men with low semen volumes and low numbers or absence of sperm.
In case of abnormal semen analysis, it may be helpful to check hormone levels, such as follicle stimulating hormone, testosterone and luteinizing hormone. About 3% of infertile men have a hormone disorder. High hormone levels can result in very low production of sperm or even no sperm. Low hormone levels can indicate congenital conditions or the use of anabolic steroids. Approximately 15% of infertile men with no sperm or very low sperm counts have a genetic abnormality that can be found through genetic testing.
Male infertility treatment will address the specific problem you have. Some fertility treatments require surgery such as Varicocelectomy, Microsurgical Reconstruction for Vasectomy and other blockages, Surgical Sperm Retrieval from testis or epididymis or Transurethral Resection of the Ejaculatory Ducts (TURED). The other treatments involve assisted sperm collection and Assisted Ejaculation.
If problems with ejaculation are present, you may be advised to freeze a semen sample prior to the treatment cycle of the female partner. This sample can be thawed and used when required.
Medications are sometimes used to treat male infertility. Antioxidant therapy (i.e., zinc, vitamin E, vitamin C, L-carnitine, N-acetylcysteine, etc.) may improve pregnancy and live birth rate in couples with male infertility.
Depending on the cause for infertility, intrauterine insemination (IUI) or assisted reproductive techniques are used to help achieve pregnancy.
Each of these treatments comes with its own cost and risks. It is necessary you discuss the most suitable course of treatment with your fertility expert.