Male infertility is very common. About one in twenty men is sub fertile and a male factor is present in half of all infertile couples. About one third of all IVF procedures are performed for male factor infertility.
It must be remembered that the testis has two distinct roles. The first is to produce the male sex hormone, testosterone, which is important for providing sex drive, erections, strong muscles. The second function of the testis is to produce millions of sperm every day, a process which occurs inside the approximately 150 metres of fine tubes in each testis. For most infertile men it is only this process which is at fault and a reduced number or poor quality of sperm are produced.
Why does this problem develop? We now believe that most cases are genetic. In other words, these men are born without the genetic information which would allow sperm production to occur normally. Small pieces of the Y, or so called male chromosome are often missing in men with severe infertility. Presumably these missing pieces of genetic information are the cause for the poor sperm production. But we need much more research before we can point to particular genes. Without that knowledge no treatment for men to improve sperm counts is likely to become available. IVF techniques offer hope now as they require very much fewer normal sperm than does Nature.
In the remaining one third of infertile men, we can find a likely cause for their infertility including :
The basic male investigation begins with a detailed history and physical examination by our andrologist. Semen analysis and serum hormonal profile (FSH, LH, Testosterone, Prolactin and TSH) represent the first line investigations. History of hernia surgery or mumps in childhood, lifestyle (excessive exercise or steam/sauna), sexually transmitted infections or trauma will all be noted. Use of medication, alcohol, drugs and occupational and environmental exposure to toxins such as heat and other chemicals will also be recorded.
The semen analysis is the first basic investigation. The sample should be collected by masturbation after 2-7 days of abstinence (no sexual intercourse or masturbation). In exceptional circumstances, semen may be produced at home or during sexual intercourse using a special condom. The sample must be submitted within an hour after ejaculation.
Sperm counts of > 15 million/ml with >40% motility and > 4% normal morphology forms are considered normal. The andrologist might suggest further investigations such as a color Doppler of the scrotum or certain dye tests such as vasography for accurate diagnosis.
Some conditions can be treated medically (such as hormone deficiencies) or surgically (varicocelectomy). If these fail to result in pregnancy you would be advised further treatment with IUI or finally ICSI which is the most successful treatment for almost all types of male factor infertility.
Very rarely, in some cases of primary testicular failure with elevated FSH levels where even microdissection TESA fails to yield sperm you might have to resort to a semen bank and avail of donor sperm for pregnancy.
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