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The importance of the male infertility evaluation
cannot be overemphasized as approximately half of infertile
couples have a male component. Even if there is an apparent
cause of infertility in the female, such as
irregular ovulation, treatment should not begin without
a recent semen analysis.
The semen analysis examines characteristics
including the number of sperm, their shape, swimming motion,
viscosity and many other characteristics. There can be severe
sperm abnormalities even if the volume of the ejaculate
is normal.
The semen analysis should be performed by a
reproductive clinic laboratory where andrologists have advanced
infertility training. Managed care plans may direct patients
to the least expensive laboratory, which may not be the
best. Andrologists have extensive experience in semen analyses
and can often document subtle abnormalities which contribute
to the infertility.
There are many causes of male infertility including
genetic abnormalities, trauma to the testicles, infection
(past and present), certain medications a varicocele and
others. Sometimes a man's occupation can reduce sperm count
as in long distance truck drivers and salesmen. The scrotum
naturally expands to reduce the temperature of the testicles
and prolonged sitting can impair this process. Prolonged
sitting in hot tubs, or even in hot baths, can also reduce
sperm counts.
A varicocele is a blockage of the veins leading
to the testicles, which must be open to help regulate temperature.
When they are blocked, the temperature of the testicles
rises inhibiting sperm production. A varicocele can also
lead to the production of antisperm antibodies and reactive
oxygen species which inhibit the sperm's ability to fertilize
the egg. Varicoceles are effectively treated with urologic
surgery, but this may not resolve the infertility problem.
Rarely, a man may have an endocrine disorder
that can be medically treated causing his infertility. In
general, there are few drug treatment options for male infertility.
None of the products promoted to increase sperm production
have been clinically proven with rigorous studies. When
drugs like Clomid are tried in the male, they must be given
for at least three months, which Is the time it takes sperm
to develop. However, the results with Clomid are generally
poor, and with out abnormal hormone levels, are not likely
to improve the semen parameters.
Intracytoplasmic
sperm injection with IVF
(in vitro fertilization) enables men with severe male
factor infertility to father a genetically related child.
With ICSI (intracytoplasmic sperm injection), one sperm
is collected from the ejaculate or directly from the reproductive
tract, and injected directly into the egg. The resultant
embryo is cultured and returned to the mother's uterus.
A vasectomy should always be considered a permanent
method of birth control. Some men cryopreserve sperm before
the vasectomy in case their family situation changes in
the future. Still, many men seek to have their vasectomies
reversed. This can be done surgically and success depends
on the skill of the urologic surgeon, where the vas deferens
were cut, how they were cut and how long prior the vasectomy
had been performed. Many specialists believe that IVF with
ICSI offer much better hope for success as over time changes in sperm production occur which may compromise sperm quality.
The male infertility evaluation, therefore,
is mandatory in the workup of the infertility couple to
optimize treatment and outcome.
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