Causes and Treatment for Low-Sperm Counts, Vasectomy Reversals & More.
While the majority of attention related to the
diagnosis and treatment of infertility is directed
toward the female, approximately 50% of all cases of
infertility are actually due to abnormalities in
sperm production or function. Unlike women, who are
born with all of the eggs that they will ever have,
men produce sperm from the time of puberty until
late in life. It typically takes between 90 and 108
days from the time that a sperm is produced in the
testicles until it is eventually ejaculated.
Therefore, in addition to medical conditions that
can adversely affect sperm production or function in
general, any event that occurs during this period of
sperm maturation can also have an immediate impact
on a man’s fertility.
The first step in the evaluation of the male involves a thorough
medical history – i.e. an office consultation during which your
physician will ask you extensively about your basic medical
condition, as well as about specific factors that could affect your
fertility. It is important to know whether you have fathered any
pregnancies, whether they resulted in an ultimate delivery of a live
child or not. In addition, we will discuss any medical illnesses
that you may have, either illnesses that you had in childhood such
as mumps, or chronic illnesses that you may have such as
hypertension. We will also explore any operations that you have
had, focusing specifically on any surgical procedures involving the
scrotum such as a varicocele repair, treatment of a spermatocele or
hydrocele, or even a hernia repair. It is also important to note if
you have undergone a previous vasectomy, with or without a vasectomy
reversal.
We will next discuss in detail any medications that you are
currently taking, as certain medications can affect both sexual
performance and sperm development and function. In addition, we
will discuss lifestyle factors such as cigarette smoking, alcohol
use, and the use of prescription and non-prescription medications.
It should be noted that cigarette smoking has been proven to have a
significant adverse effect on sperm. Similarly, alcohol
consumption, especially in excess, can adversely affect testosterone
production and ultimate sperm function. Finally, certain illicit
drugs such as marijuana can also have an adverse effect on sexual
performance and sperm production.
Your family history is also important, as certain genetic
conditions have been associated with a significant decrease in
fertility potential. An example is cystic fibrosis; the same
condition that affects cells in the respiratory system can have a
significant adverse effect on sperm production and function.
The next step in the evaluation typically involves a semen
analysis. For an optimal semen analysis, we recommend at least 48
hours of abstinence. A sperm specimen can be collected either at
home or in our facility at Austin IVF. In the event that the
specimen is collected at home, it needs to be maintained at close to
body temperature and brought to our office within an hour of the
time that it was collected. Specimens should be obtained by
masturbation, preferably avoiding any gels or other chemicals that
might interfere with the ultimate semen evaluation. Your partner
can assist in the collection of the specimen, however, please follow
the guidelines described above.
Once the specimen arrives in the laboratory, it will be evaluated
for multiple factors including volume, concentration (the number of
sperm per volume of semen), motility (the percentage of sperm that
are alive and swimming), and normal morphology. Morphology refers
to the size and shape of the sperm themselves, as normal sperm are
thought to be more likely to have normal chromosomes, whereas
abnormally shaped sperm are thought to be more likely to be
chromosomally abnormal and, therefore, non-functional.
In the event that the semen analysis shows a low sperm count,
then your physician may recommend hormonal testing. Specifically,
we will obtain a blood specimen for the evaluation of your FSH, LH
and testosterone levels. In the event that you suffer from erectile
dysfunction, we may also check a prolactin level, as over-production
of this hormone has been associated with the development of
impotence. If it turns out that your hormone levels are abnormal,
we may recommend treatment with one of several different medications
that can easily correct these problems. If, on the other hand, your
hormone levels are normal, treatment with medication will most
likely not be effective. We would therefore recommend treatment
with either intrauterine insemination (IUI) or in vitro
fertilization (IVF).
If your semen analysis is significantly abnormal, we may ask you
to repeat the test in order to ensure that the abnormal findings are
consistent. If that is the case, we will probably refer you to a
urologist (a physician trained in the diagnosis and treatment of
disorders affecting the male reproductive tract) who will perform a
physical examination. This is important to rule out the presence of
a testicular mass or other scrotal lesion that could adversely
affect sperm production.
The most commonly recommended treatments for abnormalities in
either sperm production or function include IUI or IVF. Severe
cases of male factor may require in vitro fertilization with
intracytoplasmic sperm injection (ICSI), a procedure in which a
single sperm obtained from a sperm specimen can be injected directly
into an egg that has been obtained from your partner. This
procedure is both safe and effective, and has been used since the
mid-1990s for men with severe male factor infertility.
On rare occasions, there may be a total absence of sperm
production – a condition called “azospermia”. Some types of
azospermia are caused by a blockage in the male genital tract,
whereas other types are caused by problems within the testicles
themselves. In addition to the evaluation discussed above, men with
this condition will also need to have some genetic testing to rule
out abnormalities in either the Y chromosome or one of several other
genes that can control sperm production. Even in cases where we
have no sperm in the ejaculate to work with, a variety of more
invasive treatments including microsurgical epididymal sperm
aspiration (MESA) or testicular epididymal sperm extraction (TESE) may still be successfully performed. These procedures involve
obtaining sperm through an incision in the scrotum and/or aspirating
fluid directly from either the tubules that come off the testicles
or the testicles themselves. Sperm obtained through such procedures
can then be utilized in combination with ICSI to produce healthy
children. Even if no sperm can be obtained through these
procedures, men still have an opportunity to produce children using
donor sperm.
In summary, a thorough evaluation of the male is an integral part
of the overall fertility evaluation. Diagnostic testing is easy,
and there are many effective treatments available – even in the most
severe cases.
For More Information on the Causes and Treatment of Male Infertility visit our For Men tab
