One of the contributing factors to a couple’s fertility difficulties can be problems with sperm number or function. Approximately 15-20% of infertility can be ascribed to male factor infertility. When sperm are evaluated, they are assessed for quantity, motility, and how normal they look. Results can appear normal, borderline, or severely abnormal. Severely abnormal semen analyses will often require in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) to achieve pregnancy. Normal or borderline sperm may be able to generate a pregnancy, but at a reduced chance of success.
An important item to remember is that a semen analysis does not measure male fertility; it measures sperm production. From those numbers, we try to draw connections between analyses and chances of pregnancy, but the correlation is not always exact. If problems with sperm production are identified, urological evaluation may be suggested. A urologist can perform a focused history, physical exam, and laboratory assessment, that might identify a reason behind the male’s difficulties. Many times, a hormonal or anatomic reason can be identified, which might be treated with medication or surgery.
Treatment for male factor generally involves increasing the number of normal, motile sperm having access to the eggs. This can be done with timed intercourse around the time of ovulation, intrauterine insemination, or IVF-ICSI. With intrauterine insemination, the seminal fluid is exchanged with neutral, hypoallergenic media, and the best-swimming sperm are collected after treatment in a centrifuge. Misshapen, immotile sperm are discarded, and the fraction of strong-swimming sperm is placed with a thin catheter into the woman’s uterus. Conception will still rely on the sperm’s ability to reach the egg, bind to its shell, and fertilize. If an insemination does not work, there is no way to tell where the process failed.IVF with ICSI minimizes failure by leaving the least to chance. Individual normal, motile sperm are carefully placed into oocytes, giving the highest chance for fertilization. The fertilized eggs are placed directly into the uterine cavity, minimizing the chance for ectopic pregnancy.
Other recommendations for maximizing male fertility include eating a regular diet, and avoiding tobacco, alcohol, and illegal drugs. One multivitamin per day may also help. The elements most likely to impair sperm number or quality include chemotherapy, radiation therapy, and anabolic (muscle-building) steroids. Many times, male infertility can not be “fixed”, but its effects can be minimized with intrauterine insemination or in vitro fertilization.