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Male Infertility

Fertility problems affect 15-20% of couples who are attempting to conceive. This can be due to a male factor in 50% of the cases. Evaluating and correcting any contributing male factor simultaneously with the female evaluation can expedite the process of a successful pregnancy. With today’s advancing technology, we are able to identify many causes of infertility that have previously been unexplained. There exist many simple solutions to everyday fertility problems.



Varicoceles

Varicoceles, or varicose veins around the testicles, are the most common cause of male infertility problems. They can be an isolated problem or contributing to other identifiable causes. Varicoceles are found in 40% of men presenting to an infertility clinic. These dilated veins are damaged and allow the testicles to become overheated, reflux metabolites and cause congestion. Varicoceles are also progressive lesions. If left untreated they can become problematic in future pregnancy attempts. Varicoceles are effectively treated with microsurgical varicocelectomy. Click on our link to learn more about varicoceles and their treatment.

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Diet

Patients often wonder if there are any dietary modifications that can improve their sperm count and quality or, more importantly, if any dietary habits could be hindering normal sperm production. There is research to suggest that certain supplements such as vitamin E, fructose and L-carnitine are beneficial to sperm when taken at recommended doses because of their anti-oxidant and nutritional properties. Other less studied ingredients include zinc, arginine, and vitamins C and B-12. These nutrients are the basis for many of the commercially available fertility blend supplements. However, it isn’t necessary to over-pay for these commercial supplements when equivalent generic forms are available at virtually every health store.

Soy based milk and products are becoming increasingly popular, especially for lactose-intolerant individuals. They provide good nutrition and are consideredhealthy alternatives for milk products. However, all soy-based products contain weak estrogens (genistein and daidzein) which can negatively impact sperm quality. Recent human and animal studies have shown that when these substances are given at doses equivalent to human consumption they will cause the sperm to prematurely undergo capacitation and the acrosome reaction.(Fraser, Human Reproduction, 2006) This will essentially make sperm unable to fertilize an egg. Avoiding soy based products while trying to conceive is recommended.

Video: Microsurgical Varicocelectomy performed at El Camino Urology

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Obstruction

Obstruction of the reproductive tract is the second most common cause of male infertility. This can be in the form of acquired (i.e. vasectomy, scarring after infection) or congenital (i.e. absence of the vas deferens, cysts) problems. Obstruction can occur in any portion of the reproductive tract from the epididymis and vas deferens to the ejaculatory duct. Appropriate evaluation and testing is important in identifying the location of the obstruction, the cause of the obstruction and planning for reconstructive surgery.

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Hormones

Hormones are an integral part of any infertility evaluation. Normal hormonal levels are important for normal sperm production. When abnormal, they can be an indication of other more significant problems. Correction of any hormonal abnormality is essential for a successful natural pregnancy.

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Genetic Causes

Genetic abnormalities are an increasing proportion of problems associated with male infertility. Based on the level of sperm in the ejaculate, genetic testing might be indicated. We now know that microdeletions of the Y chromosome, chromosome abnormalities and cystic fibrosis mutations are all significant contributing factors to male infertility. Genetic testing is only indicated when the findings of a clinical exam suggest that there is likely a problem. If a genetic abnormality is identified, your physician will discuss the treatment options and whether advanced genetic counseling is necessary.

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Infection/Inflammation

Previous infection such as epididymitis, prostatitis or a sexually transmitted disease can be a contributing factor to male factor infertility. Patients can develop scarring and obstruction leading to very low sperm counts or sperm with low motility. This can be diagnosed and treated if identified. Additionally, unwanted inflammation in the reproductive tract can hinder normal sperm function and fertilization. Additional testing may be required to diagnose this problem. It can be the result of previous infection or increased sperm turnover secondary to another problem such as varicocele. Medical therapy exists for treating infection and inflammation. Other therapies may be indicated to treat the underlying problem leading to infection/inflammation.

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Ejaculatory Dysfunction

Even when sperm production is normal, there can be a functional problem with getting the sperm where it needs to be at the time your wife is ovulating. This can be due to Retrograde Ejaculation or Anejaculation which can manifest itself as a normal or low semen volume. We commonly see this condition in patients with Diabetes Mellitus, Spinal Cord Injury, Neurologic Diseases, Previous Abdominal/Pelvic Surgery or Surgery for Testicular Cancer. This condition is easily treated with medication or a simple procedure.

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Recurrent Pregnancy Loss (Miscarriage)

Recurrent miscarriages can be the result of sperm chromosome abnormalities which prior to today went undiagnosed. We now know that most cases of miscarriage are due to abnormalities of a small set of chromosomes (13, 18, 21, X, Y). These chromosomal abnormalities of sperm can now be evaluated to give the couple a better understanding of the reason for the miscarriage and treatment options can be discussed to avoid future miscarriages.

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Services Provided

- Male Fertility Evaluation

Referral Services for Female Evaluation

Hormonal Testing

Semen Analysis

*Volume, concentration, motility, round cells, clumping, viscosity

Advanced Semen Testing

* Strict Morphology (Kruger)
* Sperm DNA Decondensation Test (SDD)
* Sperm DNA Fragmentation Assay (SDFA)
* Anti-Sperm Antibodies
* Sperm Penetration Assay

Genetic Testing and Counseling
* Karyotype (Chromosome Analysis)
* Y chromosome microdeletions
* Cystic fibrosis gene mutation testing

- Sperm Retrieval

* PESA (Percutaneous epididymal sperm aspiration)
* TESE (Testicular sperm extraction)
* MESA (Microsurgical epididymal sperm aspiration)
* Microdissection TESE
* Testicular Mapping
* Testicular Biopsy

Reconstructive Surgery
* Varicocelectomy
* Vasovasostomy
* Epididymovasostomy
* Vasography
* Transurethral resection of the ejaculatory duct (TURED)

Sperm Washing for Intra-Uterine Insemination
(by referring physician request)

* Regular Wash

* Soft Wash
* Isolate Wash
* Chymotrypsin Wash

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Frequently Asked Questions

Could you tell me what sperm is made of?
Sperm, like all other cells in the body, are made of protein, carbohydrates, lipids and contain genetic information in the form of DNA. What makes sperm unique is the fact that they are made up of only half of the genetic material (DNA) that all other cells are composed of. This half DNA combines with the maternal half of DNA when the sperm fertilizes the egg, recreating a complete set of DNA. This is whatmakes the child a “mix” of both parents.

How long does sperm live in the man’s body?

The normal cycle of sperm formation and maturation takes approximately 3 1/2 months. Approximately five days after the completion of maturation, sperm has a gradual decay in survival. This is one of the reasons why we recommend couples not to abstain for more than 5 days from intercourse when they areundergoing male fertility evaluation. Optimal sperm quality is seen in ejaculates with abstinence periods between 2-5 days.

What is the average number of sperms in the average ejaculate?

The average sperm concentration in the ejaculate of fertility proven men is 60-120 million sperm per ml. However, the WHO (World Health Organization) has established a cutoff of 20 million sperm per ml as a normal value below which we begin to see problems with fertility.

How long does it take the sperm to get to the egg?

Sperm have been shown to appear in the fallopian tubes as early 10 minutes after deposition into the vagina (i.e. sexual intercourse). They reach a steady state concentration in the fallopian tubes in 35 minutes. The sperm fertilizes the egg in the fallopian tubes.

Could you tell me how the sperm knows how and where to swim? Are there any female processes that help the sperm do that?

The sperm and egg send molecular signals to each other that are referred to as “chemotactic” factors. This is the same way that many cells in the body communicate with one another. This signaling mechanism is complex and researchers are not certain which are the exact messengers in this process.

Is there a way I can check my fertility status or sperm count at home?

here are commercially available male fertility tests. Unfortunately, these tests are unreliable and only evaluate the simplest aspects of a man’s sperm count. A normal result does not rule out a male factor for infertility. A formal semen analysis is a much more complex test. Your physician may order more specific semen tests based on your evaluation. There are many other factors that can be found to be a contributing factor to a couple’s fertility problem even when these “home” tests are normal.

I have recently heard that experts now know that successful sperm use their tails to make one final jump into the egg — and new research is revealing just how it happens. Can you explain that?

The final step in the sperm’s long journey after it encounters the egg is to fertilize the egg. The sperm penetrates the tough outer layer of the egg called the zona pellucida. This requires the sperm to undergo a process called the acrosome reaction where enzymes help to breakdown some of this outer layer. The sperms whip-like tail motion helps the sperm with the final penetration through this layer.

What kind of tips can you give on how a man can help boost sperm count?

The best general guidelines for any couple wanting to conceive is that anything that is good for their general health is good for their sperm. Conversely, anything harmful to their general health is bad for sperm. It is important to know that sperm represent some of the most sensitive cells in the body with respect to their ability to tolerate extreme conditions (i.e. heat, toxins, drugs). A healthy diet, replete with antioxidants with avoidance of situations which place the testicles in extreme heat is considered good general advice.

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