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When considering the cause for infertility, women are not alone – a male factor contributes to the etiology of infertility in 40-50% of couples presenting for evaluation.
Just like follicle and egg recruitment and growth, sperm production is dependent on a delicate balance of messages from the brain. Generally, in pre-testicular causes for abnormal sperm counts, the messages sent from the brain are low, and adequate support for sperm production can not be accomplished without replacement of these messages. Causes can include genetic conditions (Kallman Syndrome), Obesity, or any treatment directed to the areas which produce these messages (like a prior history of radiation treatment to the brain).
Testicular factors include those conditions related to the testes which may affect sperm production. Causes include primary testicular failure (which is often genetic in etiology), trauma, hydrocele or varicocele, a previous history of mumps or malaria, age, history of testicular cancer or exposure to chemotherapy.
Post-Testicular Factors (Obstruction)
Post testicular factors include any obstructive abnormality to the male genital tract as well as any problem related to ejaculation. This can include absence of the vas deferens (a condition that can be seen in men who carry mutations for cystic fibrosis), obstruction of the ejaculatory ducts or vas deferens, history of a vasectomy, infection (prostatitis, or inflammation of the prostate), and erectile dysfunction.
Diagnosis and Evaluation
The initial steps for evaluating for a male factor for infertility includes a detailed medical history and a semen analysis. Following the semen analysis, especially if no sperm (a condition called azoospermia) or low concentration of sperm (a condition called oligospermia) are seen, your Team RMI physician may additionally obtain blood work, which will include an assessment of the messages sent from the brain to drive sperm production (FSH) and the major male sex hormone (testosterone), and possibly a genetic evaluation may also be suggested. Referral to a urologic fertility specialist may also be suggested for a complete physical examination.
The treatment for male factor infertility is generally related to the cause, but in most cases male factor infertility can be treated through the use of in vitro fertilization (IVF) or intrauterine insemination (IUI). Lifestyle modifications, just like in women, can be helpful in optimizing male fertility. These lifestyle modifications can include healthy diet and exercise, smoking cessation, and limitation of alcohol intake.
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