At Reproductive Medicine Institute (RMI), we strive to offer our referring community and our shared patients the most current information on Assisted Reproductive Technologies (ART). In this letter we discuss the complexity of male infertility.
Male Infertility – What You Should Know
Male infertility is a complex process and contributes to the inability to conceive. Male infertility or subfertility is identified as the primary diagnosis in approximately 1/3 of patients seeking treatment and a contributory factor in another 1/3 of patients. To get your partner pregnant you must produce enough healthy functional sperm that is properly transported from the testicles and ejaculated out of the penis into your partners reproductive tract.
The basic male fertility evaluation begins with a semen analysis that evaluates your ejaculate for volume, the number of sperm, the shape of the ejaculated sperm, movement patterns of the sperm and health of the ejaculatory process. Semen parameters vary day to day. The health of male reproductive tract function can be assessed with a well performed semen analysis.
Infertility may be caused at many different points during the roughly three months of production to ejaculation. Identifying the cause of infertility is often the first step to treating it. Given the timeline for sperm production, the effectiveness of treatment may take up to three months to be seen.
A detailed medical history can help to identify causes and possible treatments for a specific condition. There are numerous medical causes that can interfere with fertility potential. A few are addresses below, however, this is not an all-inclusive list.
Problems associated with semen analysis results can be divided into two broad categories:
Obstructive Azoospermia is a defect in one of the many tubules that transport sperm.
Blocked tubules can be due to various causes including infection, trauma, abnormal development, inherited genetic conditions. If a production issue is ruled out, sperm can be retrieved directly from the testicle via surgical sperm retrieval procedures (PESA, MESA, TESA).
Infections may interfere with transport anywhere along the system. Epididymal infections caused by chlamydia, gonorrhea or UTIs can create blockage, as can repeated urinary tract infections (UTI). Identification and treatment of the infection can improve sperm quality by treating the infection and resulting inflammation. If an infection causes permanent testicular or transport damage, it may still be possible that sperm can be retrieved directly from the testicle via PESA, MESA or TESA.
A very common cause of obstruction is a vasectomy. Vasectomy reversal is a viable treatment option; however, successful reversal is correlated with the time since the original vasectomy. The most successful reversals are less than 5 years from the vasectomy. An alternative to vasectomy reversal is the Percutaneous Epididymal Aspiration (PESA) of sperm directly from epididymis as vasectomies do not affect sperm production.
Inguinal hernia repair, particularly when performed at childhood, is one common cause for vasal obstruction and obstructive azoospermia due to vasal injury. If you are undergoing an evaluation for fertility potential, make sure to notify your provider of any hernia surgeries you may have undergone.
Mumps have been associated with sub-fertility by causing mumps-related orchitis (testicle inflammation). This testicular swelling can create an obstruction leading to decrease in sperm parameters.
Non-Obstructive Azoospermia is the diagnosis made when no sperm are present and a blockage to the transport system cannot be identified. This diagnosis is associated with sperm production.
A common non-obstructive reversible cause of male sub-fertility is a swelling of the veins that drain the testicle called a varicocele. Think “varicose vein” of the testicle. The exact mechanism of the etiology of reduced sperm quality is unknown, but surgical repair or IVF with ICSI are not uncommon treatments.
Chromosome defects such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Y-chromosome micro-deletions can affect sperm quality and production.
Hormonal imbalances may impact sperm production. The imbalance can arise in any hormonal system including the hypothalamus, pituitary, thyroid and adrenal glands. Testosterone is a critical hormone to sperm production. It is well documented that life-style choice of such as the use of testosterone or anabolic steroids has a profound impact on sperm production by creating abnormalities in the normal hormonal feedback loops that drive sperm production.
Exposure to environmental toxins such as industrial chemicals, heavy metals, radiation have been associated with male infertility and sub-fertility. Many chemotherapeutic agents are known as gonado-toxins that can affect sperm stem cells, and subsequently impair sperm production.
What are other factors that can affect sperm production or function?
Lifestyle choices including the use of recreational drugs (alcohol, marijuana, and cocaine) is associated with male sub-fertility. Tobacco use is strongly associated with lower sperm count. Use of anabolic steroids to stimulate muscle strength and growth profoundly affects the testicles and sperm production. Again, it is important to note that lifestyle changes may not be reflected in a semen analysis for three or more months.
Weight affects sperm production by interfering with hormonal systems. Weight may also be involved with overheating of the testicles. Weight loss has been correlated with improved semen parameters.
Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and most are inconclusive, activities which may elevate intra-testicular temperature (frequent use of saunas or hot tubs, distance bike riding, wearing tight clothing or working on a laptop computer for long stretches of time) may affect sperm production.
At RMI, our goal is for every patient to have a healthy, successful pregnancy. We understand that each patient experiences their own unique journey through fertility. Our team is here to provide you with the information needed to meet your needs while giving you the best chances of having a successful pregnancy and a healthy baby.