Male Reproductive Medicine and Surgery Program

Male Factor Infertility

What is infertility?

Male Factor Infertility

The American Society for Reproductive Medicine (ASRM), the premier reproductive medical society in the United States, recommends both members of an infertile couple receive an evaluation in order to expedite and improve reproductive goals.

Infertility is defined by the ASRM as a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors, including the following:

Who is affected by infertility?

The average chance to conceive for a normally fertile couple having regular, unprotected intercourse is approximately 15-25 percent during each menstrual cycle. In most couples, conception occurs within about 12 months. However, infertility affects about 15 percent of couples of childbearing age. Infertility is not just a woman's concern. A problem with the male is a cause of infertility in 50 percent of infertile couples. About one-third of infertile couples have more than one cause or factor related to their inability to conceive.

What are the risk factors for men regarding infertility?

The following is a list of some risk factors related to male infertility (also called male factor or male factor infertility):

What causes male factor infertility?

The cause of male infertility is commonly divided into 3 main categories:

  1. Pre-testicular – factors that affect the normal hormonal regulation of the testicle (Examples: obesity, low testosterone, medications, steroids, narcotics)
  2. Testicular – factors that affect normal sperm production by the testicle (Examples: undescended testicles, cigarette or marijuana smoke, EtOH, trauma to the testicle, prior chemotherapy, a history of testicular cancer, genetic factors, genital infections, prescription drugs)
  3. Sperm disorders - problems with the production and maturation of sperm are the most common causes of male infertility. Sperm may be immature or abnormally shaped (teratospermia), unable to move properly (asthenospermia), or be produced in abnormally low numbers (oligospermia) or seemingly not at all (azoospermia). This problem may be caused by many different conditions including the following:

    • infectious diseases or inflammatory conditions such as the mumps virus
    • endocrine or hormonal disorders such as Kallmann's syndrome or pituitary problem
    • immunological disorders in which some men produce antibodies to their own sperm
    • environmental and lifestyle factors
    • genetic diseases (most are associated with sperm abnormalities, either directly or indirectly).  Indeed, up to one third of the male genome is dedicated to male reproduction thus it makes sense that many problems in sperm production and transit may be due to genetic causes:
      • Chromosomal abnormalities - men with an extra X sex chromosome, known as Klinefelter syndrome, often do not produce sperm or produce very low quantities of sperm; in some persons, there are the usual number of chromosomes (46) in the nucleus (center) of cells, but rearrangements in the chromosome material, where a piece of a chromosome has exchanged places with another, has taken place; men with either azoospermia or oligospermia have a higher frequency of chromosome rearrangements than is found in the general population.
      • Abnormal Y chromosome - in some persons, there are the usual number of chromosomes (46) in the body cells, but small sections of the Y chromosome are missing or deleted; anywhere from 3 to 30 percent of men with either azoospermia or oligospermia have deletions in the Y chromosome. This can have implications for fatherhood and the gender of the offspring.  It is important to understand that men who have genetic problems which cause their infertility, such as a deletion in the Y chromosome, can pass this problem to their sons, who would also have infertility, if they elect to use their own sperm in achieving a pregnancy.
  4. Post-testicular – factors that affect the ability of the sperm to travel from the site of production (testicle) to leave the body in the ejaculate.
    Examples: hernia repair, absent vas deferens, ejaculatory duct abnormalities, vasectomy, genital tract infection, genetic factors, retrograde ejaculation, erectile dysfunction.
    • Genetic Diseases: Cystic fibrosis - an inherited condition that typically involves the lungs and pancreas, but can present also as a cause of infertility with or without mild sinus problems; 6 to 10 percent of men with obstructive azoospermia have congenital bilateral absence of the vas deferens (CBAVD), which means they were born without the vas deferens; of these, over 70 percent may have cystic fibrosis or carry a mutation in the cystic fibrosis gene.

How is male factor infertility diagnosed?

A complete medical history involving a detailed evaluation of development, family conditions, and lifestyle patterns and habits.

Physical examination

Genetic testing as indicated

Treatment for male factor infertility:

Examples of treatment include lifestyle modification, microsurgical reconstruction, microsurgical sperm retrieval, microsurgical varicocele repair, tailored medical therapy, assisted ejaculation

Specific treatment for male factor infertility will be determined by your physician based on:

There is a range of treatment options currently available for male factor infertility. Treatment may include:

Lifestyle modification

Many habits, exposures, and medications that cause impairments to testicular function can be identified and either eliminated or modified with resulting improvements in sperm and testosterone levels.

Tailored medical therapy

Our goal is to optimize the hormonal axis as well as testicular microenvironment for sperm maturation in order to improve sperm production and function.

Surgery

Surgical therapy in male infertility is designed to overcome congenital or acquired anatomical barriers that impede sperm production and maturation or delivery. Epididymal or vasal obstruction can be corrected microsurgically to improve sperm delivery. Ejaculatory obstruction can be corrected endoscopically. Impaired testicular function and sperm production due to varicocele can be improved microsurgically.

In certain men, sperm must be directly harvested from the scrotum. In such cases, sperm can be harvested percutaneously or microsurgically directly from the testis or epididymis. Our world-renowned embryologists evaluate the sperm immediately to provide real time interpretation and help guide the optimal sperm extraction.

Artificial insemination

Artificial insemination involves the placement of relatively large numbers of healthy sperm either at the entrance of the cervix or into the partner's uterus, bypassing the cervix, to have direct access to the fallopian tubes.

IVF

In vitro fertilization (IVF) with or without ICSI (intra cytoplasmic sperm injection) have been used for the treatment of male infertility. As is the case with artificial insemination, IVF and similar techniques offer the opportunity to prepare sperm in vitro, so that oocytes are exposed to an optimal concentration of high quality, motile sperm.

Intracytoplasmic sperm injection or ICSI

This treatment is used to facilitate sperm penetration by injection of a single sperm into the oocyte. Fertilization then takes place under the microscope. State-of-the-art techniques currently allow men in whom only a handful of sperm can be retrieved to become fathers.

Other aspects of male infertility

Emerging research suggests that male fertility may be a window into a man’s future health. As such, infertility may be a sign of other health ailments. As thought leaders in the field, our experts will work toward the improvement of the man’s overall and reproductive health.

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