For male factor infertility, approximately 40% of men identified with abnormal sperm characteristics will have no known causes for these abnormalities. In these cases, there are no known treatments to improve the quality of the semen. For some men, there may be treatment for the suspected cause of infertility, but the semen quality may still not be adequate for conception to occur. Many men with abnormal semen characteristics have fathered children.
Smoking, excessive alcohol, recreational drugs, anabolic steroids, and frequent hot tub/sauna use are among factors that are known to possibly be detrimental to male fertility.
Testing: Semen analysis.
Treatment: Identify the reason and take steps to correct the problem (quit smoking, lose weight, etc.). Multivitamin with antioxidants. After any intervention, at least 3 months will be required before any improvement can be expected.
Chronic medical problems such as diabetes, high blood pressure, thyroid disease, and obesity can affect male sexual function and the quality and quantity of the sperm.
Testing: Semen analysis, possible hormone testing.
Treatment: It is important to work with your GP to optimize the treatment of your medical condition. While many of these problems cannot be cured, making sure that you are on the best possible treatment will improve your general health and potentially increase your chances of initiating a natural pregnancy. Assisted reproduction, such as IUI or IVF-ICSI, can help in situations when natural pregnancy does not occur.
A dilation of blood vessels in the scrotum causes abnormal circulation around the testicles, potentially affecting the normal production of sperm. If the dilated blood vessels are very large, varicocoeles can often cause testicular pain. However, many men with varicocoeles will not have any symptoms and can have normal fertility.
Testing: Semen analysis, examination by a urologist, scrotal ultrasound.
Treatment: Varicocoele ligation or embolization are different techniques to restore normal circulation in the scrotum. These treatments are not always successful in restoring normal sperm production, so your urologist will discuss if you are a good candidate for such treatments. Assisted reproduction, such as IUI or IVF-ICSI, can be used if the problem cannot be fixed.
Some men will produce sperm normally, but release only a very small amount of semen due to a physical obstruction. Some men are born with such problems, while others develop them over time. Depending on the nature of the blockage, only a small concentration of sperm may be present (oligospermia), while in others, no sperm will be present (azoospermia). There are numerous problems that can be responsible for an obstruction. Thus, a referral to a urologist for a full evaluation is necessary.
Testing: Semen analysis, examination by a urologist, blood testing for hormones and genetics, scrotal ultrasound.
Treatment: Depending on the cause for the obstruction, the urologist will determine the most appropriate treatment. Options include surgical procedures to correct the obstruction, or minor procedures to obtain sperm to be used for IVF-ICSI.
At the time of ejaculation, the semen may be diverted to the bladder instead of exiting through the penis. This may be due to a malfunction in the pelvic nerves or a physical obstruction such as an enlarged prostate gland.
Evaluation: Semen analysis with an examination of the urine after ejaculation, examination by a urologist.
Treatment: Sometimes, over-the-counter medical treatments may remedy the situation. Other times, the sperm retrieved from the urine can be concentrated and used for IUI or IVF-ICSI
Sometimes, family plans change, and many men wish to reverse the effects of a vasectomy.
Testing: Consultation with a urologist.
Treatment: A vasectomy reversal is a surgical procedure that can often restore natural fertility in men. Your urologist will discuss if you are a good candidate and how successful the procedure can be expected to be. An alternative is a percutaneous epididymal sperm aspiration (PESA) procedure to obtain sperm for use in IVF-ICSI. Before deciding which procedure is appropriate, the evaluation of the female partner is important to consider.
Certain cancers or cancer treatments may prevent future sperm production. We recommend discussion with your oncologist about the possible sterilizing effects of cancer treatment, and a consultation with a fertility specialist to freeze sperm for future use. If you have already had cancer treatment, a semen analysis can determine if you are still producing sperm.
Treatment: Sperm can by frozen on an emergency basis so that cancer treatment need not be delayed. If possible, 2 specimens should be obtained so that multiple attempts at future pregnancies can occur, either through IUI or IVF/ICSI. For those who have already had cancer treatment, a semen analysis will determine if sperm is available for IUI or IVF/ICSI. If you are no longer producing sperm, donor sperm can be considered.
The impact of male age on fertility is still controversial. Newer evidence suggests that it may be more important than previously thought. However, men produce sperm throughout their entire lives, and the decline in sperm quality is probably not significant until the mid-40’s at the earliest. There is also some evidence that increasing male age may be associated with some conditions in the offspring, such as autism, schizophrenia, and some genetic conditions.
Testing: Semen analysis, possibly a sperm DNA fragmentation test.
Treatment: A multivitamin with antioxidants is recommended. Depending on the quality of the sperm, IUI or IVF-ICSI may improve fertility. Autism and schizophrenia cannot be detected with genetic testing of the embryo.
Patients who carry certain genetic conditions may have severely decreased or completely absent sperm production for different reasons. These conditions are quite rare and may not cause any symptoms other than infertility.
Testing: Semen analysis, genetic testing, an examination by a urologist. Testing the partner for genetic disease may also be necessary.
Treatment: The treatment depends on the genetic problem. For men who carry Cystic Fibrosis, a relatively simple procedure can obtain sperm to be used for IVF-ICSI. For men with other genetic problems such as Klinefelter’s syndrome or Y-microdeletions, more invasive procedures may be necessary to obtain sperm from deeper in the testes. Genetic testing of the embryo called Preimplantation Genetic Diagnosis (PGD) can also can be considered, depending on the condition.