IHR's Male Infertility Program provides the experience, technology and surgical tools to address all male infertility issues.
Just as the causes of female infertility can be multifaceted, male infertility can be similarly challenging and equally deserving of a full investigation. Male infertility is any condition in which the man adversely affects the chances of initiating a pregnancy with his female partner. Most commonly, those problems arise when the man is unable to produce or deliver fully-functioning sperm. The IHR male infertility experts work closely with couples undergoing the many different types of assisted fertility treatments available. We are renowned for our specialized knowledge and high infertility success rates even in difficult cases. IHR's expertise in male infertility lies in our willingness and ability to individualize our approach to best suit each and every one of our patients. If you have any questions as you review the material on male infertility, please contact us for a FREE Male Infertility E-Mail Consultation.
A semen analysis is the primary test used to determine male infertility. Semen analysis results can be normal, mildly, moderately or severely abnormal, or may show no semen at all — a condition called azoospermia. Whatever the severity of semen analysis, IHR has the expertise to provide highly successful fertility solutions for the majority of affected males.
IHR male infertility experts will be interested in any factor, including possible structural and other defects in the reproductive system, hormonal deficiencies, illness or even trauma that might be impairing your fertility. IHR male infertility investigation will center on many possible combinations of factors, the most common of which are:
Sperm disorders: Problems with the production and development of sperm are the most common problems of male infertility. Sperm may be underdeveloped, abnormally shaped or unable to move properly. Or, normal sperm may be produced in abnormally low numbers (oligospermia) or seemingly not at all (azoospermia).
Varicoceles: These dilated scrotal veins are present in 16 percent of all men but are more common in infertile men—40 percent. They impair sperm development by preventing proper drainage of blood. Varicoceles are easily discovered on physical examination since the veins feel distinctively like a bag of worms. They may also be enlarged and twisted enough to be visible in the scrotum. This is the most common correctable cause of male infertility.
Retrograde ejaculation: Retrograde ejaculation occurs when semen pushes backwards into the bladder instead of out the penis. This is caused by the failure of nerves and muscles in the bladder neck to close during orgasm. It is one of several difficulties couples may have delivering sperm to the vagina during intercourse. Retrograde ejaculation can be caused by previous surgery, medications or diseases affecting the nervous system. Signs of this condition may include cloudy urine after ejaculation and diminished or "dry" ejaculation with orgasm.
Immunologic infertility: Triggered by a man's immunologic response to his own sperm, antibodies are usually the product of injury, surgery or infection. In attacking the sperm, they prevent normal movement and function of the sperm. Although researchers do not yet understand just exactly how antibodies damage fertility, they know that these antibodies can make it more difficult for sperm to swim to the uterus and penetrate eggs.
Obstruction: Blocking sperm from its normal passage, obstructions can be caused by a number of factors, such as repeated infections, prior surgery (including vasectomy), inflammation or development problems. Any portion of the male reproductive tract, such as the vas deferens or epididymis, can be obstructed, preventing normal transport of sperm from the testicles to the urethra, where it leaves the body during ejaculation.
Hormones: Hormones produced by the pituitary gland are responsible for stimulating the testicles to make sperm. Therefore, when levels are severely low, poor sperm development can result.
Genetics: Genetics play a central role in fertility, particularly since sperm carry half of the DNA mix to the partner's egg. Abnormalities in chromosomal numbers and structure as well as deletions on the important Y chromosome present in normal males can also impact fertility.
Medication: Certain medications can affect sperm production, function and ejaculation. Such medications are usually prescribed to treat conditions like arthritis, depression, digestive problems, infections, hypertension and even cancer.
IHR's urologist has expertise in the following areas: evaluation and treatment of male infertility, microsurgical vasectomy reversal, sperm procurement techniques, microsurgical varicocele ligation, management of testicular failure and hypogonadism, sperm cryopreservation/banking, evaluation and treatment of ejaculatory disorders, general urology
The treatment for male infertility depends on the specific problem. However, many times there are a mix of medications, surgical approaches and assisted reproductive techniques (ART) available to overcome the underlying fertility problems. The options include:
Surgery: Minor outpatient surgery (varicocelectomy) is frequently used to repair dilated scrotal veins (varicoceles). Studies have shown that repairing these dilated veins results in improved sperm movement, concentration and structure. In some cases, obstruction causing infertility can also be surgically corrected. In the case of a previous vasectomy, surgery using an operating microscope has been found to be very successful in reversing the obstruction.
Medication: Drugs are key in correcting retrograde ejaculation and immunologic infertility. In addition, pituitary hormone deficiency may be corrected with drugs such as clomiphene or gonadotropin.
If these techniques fail, fertility specialists have a variety of other high-tech assisted reproductive techniques that promote conception without intercourse. Depending on your problem IHR may consider:
Intrauterine insemination (IUI): By placing sperm directly into the uterus via a catheter, IUI bypasses cervical mucus that may be hostile to the sperm and puts them close to the fallopian tubes where fertilization occurs. IUI is often successful in overcoming sperm count and movement problems, retrograde ejaculation, immunologic infertility and other causes of infertility.
In vitro fertilization (IVF): Refers to fertilization taking place outside the body in a laboratory Petri dish. There, the egg of a female partner or donor is joined with sperm. With IVF, the ovaries must be overly stimulated, usually with fertility drugs that allow retrieval of multiple mature eggs. After 48 to 72 hours of incubation, the fertilized egg (embryo) is inserted in the uterus and normal pregnancy should result. While IVF is employed mostly for women with obstructed fallopian tubes, it is occasionally used for men with oligospermia.
Intracytoplasmic sperm injection (ICSI): A variation of in vitro fertilization, this procedure has revolutionized treatment of severe male infertility, permitting couples previously thought infertile to conceive. It involves injecting a single sperm directly into the egg with a microscopic needle and then, once it is fertilized, transferring it to the female partner's uterus. Your doctor is likely to use ICSI if you have very poor semen quality or lack of sperm in the semen caused by an obstruction or testicular failure. In some cases, sperm may be surgically extracted from the testicles or epididymis for this procedure.
Testicular sperm extraction (TESE): If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab. This would be done as part of an IVF treatment.
IHR has treatments for a variety of conditions, including ovulatory dysfunctions, endometriosis, immunological infertility and many others. Perhaps less known is our work with individuals and couples who are considering assisted reproduction, but who are uncertain of their next step. We encourage anyone, before they make a decision, to consult with us. Currently, we are offering a FREE Male Infertility E-Mail Consultation.