Diagnosis

• Overview
• Initial Consultation
• The Infertility Evaluation
• Follow-up Consultation
• Diagnostic Screening Tests
• The Female Infertility Evaluation
• The Male Infertility Evaluation

The Male Infertility Evaluation

Male factor is the sole cause of infertility in up to 40% of infertility cases, and it can be caused by a variety of different conditions. Male infertility can occur as a result of hormonal abnormalities, infection, trauma, chemotherapy, radiation, or surgery to the testicles. It may also be caused by a varicocele, which is an enlarged vein or group of veins within the scrotum. Recent scientific studies have also shown that in many cases of male infertility, there may be a significant genetic component, which may be passed on to male offspring. Despite the above causes, a significant portion of male infertility remains unexplained.

* Semen Analysis: This test is performed by our highly skilled andrologists at Austin IVF, who perform microscopic evaluation of the sperm using strict guidelines developed by the World Health Organization. Since this test is such an important part of the evaluation of the male partner, and since it is so often performed incorrectly by inexperienced technicians, we ask that this test be performed at Austin IVF. Information obtained from the semen analysis, specifically sperm concentration (number of sperm per cc of semen), sperm motility (the percent of sperm that are alive and swimming) and normal morphology (the percent of sperm that have a normal shape) will help your physician determine what technique to use to maximize the likelihood of fertilization. These options include intercourse timed around the fertile period of the woman’s cycle, intrauterine insemination (IUI), conventional IVF, or IVF with ICSI (intracytoplasmic sperm injection).

* Anti-sperm antibody testing: In rare occasions, men may make antibodies to their own sperm. Under normal circumstances, sperm are kept out of a man’s circulatory system by a physiologic barrier. If this barrier is violated – common causes include infection or a surgical procedure - sperm may be exposed to the circulatory system resulting in the formation of antibodies. Antibodies are small proteins in the blood that may attack otherwise normal sperm. As a result, the sperm may not swim as well or they may not be able to bind to the egg. This condition is easy to successfully counteract – but in order to successfully treat it, we must first make the diagnosis. Therefore, in the presence of a history of infection or scrotal surgery we will recommend the performance of an antibody test for couples proceeding to IVF. This test will be performed by one of our andrologists at Austin IVF and only requires the male to provide a sperm specimen.

* Hormonal Testing: Like oocyte development, sperm development occurs in response to hormonal stimulation. Whereas FSH stimulates sperm development, LH stimulates the testicles to make testosterone. An abnormality in either FSH or LH production can lead to a marked decrease in sperm production with or without a decrease in testosterone production. Such abnormalities are easily corrected by giving the male Clomiphene Citrate. This medication works by raising the production and secretion of both FSH and LH, frequently resulting in a marked increase in sperm production. The TFC physicians were among the first to perform a study on the use of Clomiphene Citrate in men with hormonal abnormalities, you can follow the link to our studies under Research.

Overproduction of another hormone, prolactin (hyperprolactinemia), may also produce abnormalities in sperm production as well as a decreased sex drive (libido). It is important to share information regarding a change in your libido with your physician in order to rule out a problem with prolactin production. If present, hyperprolactinemia is usually easily correctable with oral medication.

* Karyotype: In the event that the male partner has a very low sperm count, your physician may recommend evaluating his chromosomes. A simple blood test may identify potentially significant abnormalities which can prevent fertilization and pregnancy. Subsequent treatment options may include Pre-implantation Genetic Screening with IVF or the use of donor sperm.

* Y Chromosome Deletion Testing: This test may also be ordered when the sperm concentration on a semen analysis is very low. In some cases of very low sperm concentrations, structural abnormalities (specifically deletions) of a portion of the Y chromosome that controls development of sperm in the testicles can lead to decreased production of sperm, lowering the pregnancy rate significantly. Using the advanced reproductive technique of IVF with ICSI, fertilization can be achieved in some of these deletions; however it is possible that these abnormalities may be passed on to any male offspring.

* Sperm Chromatin Structure Assay (SCSA): This is a relatively new diagnostic test which may be important in cases of recurrent pregnancy loss and failed fertilization possibly related to male factor infertility. This test analyzes the sperm for certain types of DNA fragmentation. Studies have suggested that significant abnormalities may predict reduced probability for natural conception. Fortunately, TFC’s advanced procedures like IVF with ICSI may compensate for such abnormalities. However, even with these advanced techniques, the scientific data to date suggests that a significant decrease in the pregnancy rate as well as a doubling of the spontaneous pregnancy loss rate may result when these defects are present. As this test is still new and not yet conclusive, we typically recommend it only for certain patients who suffer from otherwise unexplained recurrent pregnancy loss or unexpected and otherwise unexplained repeated unsuccessful IVF cycles.

* Cystic Fibrosis (CF) Genetic Screening: While we support CF testing for any of our patients, men with a complete absence of sperm (azospermia) should definitely be tested. Several years ago, an association was found between men who carry the CF gene and a condition called congenital absence of the vas deferens. The vas is the tube that carries sperm from the testicles to the penis and, in its absence, sperm cannot be ejaculated. This condition can be treated through the use of a procedure called microsurgical epididymal sperm aspiration (MESA). In this procedure, a urologist can extract sperm from the tubules coming directly off of the testes. Our embryologists can then inject these sperm into oocytes via the ICSI procedure, and this frequently results in the birth of healthy babies. As with several other genetic diseases, the successful performance of ICSI may unfortunately still result in transmission of this condition to the offspring.