The three major factors influencing the spontaneous probability of conception are the time-to-pregnancy, the age of the female partner, and the underlying disease-related infertility (male and/or female). Infertility is a prevalent condition in the American society. It is estimated to affect 15% of reproductive-aged couples worldwide. Males are found to be solely responsible for 20-30% of infertility cases, but it is now apparent that sperm abnormalities can contribute to an outstanding 50% of cases overall (alone or combined with female factors). Indeed, recent estimates indicate that disorders of the male represent the most common single defined cause of infertility.
What are the symptoms of male infertility? In most cases, there are no obvious signs of infertility. Intercourse, erection and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye. Medical tests are needed to find out if a man is infertile. A thorough history and physical examination is mandatory followed by analysis of the semen at a qualified laboratory.
What are the known causes of male infertility? Male infertility is caused by problems that affect either sperm production or sperm transport. Through medical testing, we may find the cause of the problem. Some men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are released do not work properly in terms of motility and shape (morphology). Sperm transport problems are found in others, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen, either of congenital or acquired origin. Other less common causes of infertility include: sexual problems/dysfunctions; low levels of hormones made in the pituitary gland that act on the testes; sperm antibodies; and more increasingly found “iatrogenic” causes, i.e., use of testosterone-derived products (that indeed scan suppress sperm production!!!). Semen decline that has been observed over the years, endocrine disrupting chemicals/toxics, and consanguinity are other factors that may be involved.
Although contemporary therapies have undoubtedly enhanced the opportunities for conception in couples suffering from male infertility, often these solutions overlook the absence of a defined pathophysiological diagnosis. Male infertility, unfortunately, is still considered “idiopathic” in a large proportion of cases. Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable moderate and severe male factor infertility. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better DNA/chromatin integrity, the overall pregnancy rates remain suboptimal in some subgroups of male patients (for example men with severe testicular/genetic deficiencies).
Optimizing general life-style measures and treating the underlying male infertility factor (if known or suspected) before ICSI seems to be a promising way to improve ICSI outcomes. At Sher Fertility Institute New York, we provide you with the best guidance and care for both female and male members of the couple.
For further information please call Sher Fertility Institute New York at (646) 792-7476.