|
|
 |
"Up to 50% of infertility is male factor. Therefore, 50% involves female factor. Some couples will require help in achieving a pregnancy. This is called Assisted Reproduction."
Sarah K. Girardi, M.D., F.A.C.S
Chief, Division of Infertility and Female Urology, North Shore University Hospital, Manhasset
Male infertility
Infertility is widely defined as the inability to conceive after at least one year of unprotected intercourse. The majority of couples are able to conceive within this time period, but approximately 15% of couples will need assisted reproductive efforts to achieve a pregnancy. These efforts require two specialists, a urologist for the man and a gynecologist for the woman.
In up to half of couples, a problem with the male will be responsible for the inability to achieve a pregnancy. This is why the evaluation of the male is so important.
Evaluation of the Male
- History—A thorough history is obtained through a combination of interview and questionnaire.
- Physical examination—performed in the office in five to ten minutes and often reveals the explanation for the infertility.
- Semen analysis—Specimens are collected through masturbation by the patient prior to the initial visit. This test is the cornerstone of the infertility evaluation. (This test is performed by an outside laboratory.)
- Blood tests—Levels of testosterone and several pituitary hormones can be very helpful in discovering the source of a man's infertility. Genetic testing is performed in select cases.
Etiology of Male Infertility
- Illness—Any illness, especially one associated with fever can affect sperm count or quality for up to 3 months.
- Obstruction—Some men have a partial or complete blockage to explain low or zero sperm counts. Some blockages can be repaired.
- Sexual Dysfunction—An inability to achieve or maintain erections can dramatically reduce a couple's chance of achieving a pregnancy. In some cases medications can correct these conditions.
- Hormone Disorders—Thyroid disease, hormone supplements and pituitary disorders can reduce sperm counts. Often medications or surgery can correct these disorders.
- Trauma (to reproductive organs)—Any injury to the testes or penis can potentially reduce sperm count and quality. Surgical correction is sometimes necessary.
The Role of the Urologist
The role of the urologist in the evaluation of infertility is to identify any correctable forms of infertility and provide treatment, or to establish that there are no correctable conditions and refer the couple to a specialist for assisted reproduction.
Correctable Conditions
- Varicocele—dilated veins of the spermatic cord. This condition occurs in up to 35% of men with primary infertility and up to 85% of men with secondary. This condition can be treated with surgical repair in most cases.
- Hypogonadism—A low serum testosterone level. This can negatively impact sperm count and quality. This condition is usually treated medically.
- Obstruction—most blockages in the sperm transport system can be treated. Treatment options usually require a microsurgical procedure.
- Retrograde ejaculation—sometimes there is a failure of the bladder neck to close, resulting in sperm traveling into the bladder during ejaculation. This condition can often be treated with medicine alone.
Assisted Reproduction
When there is no identifiable cause for infertility, or when other treatments have failed, couples are usually recommended to pursue one of the forms of assisted reproduction available.
- IUI or Artificial Insemination—This is the simplest form of assisted reproduction. The man is asked to provide a semen sample around the time his wife is expected to ovulate. That sample is washed to enrich for the fittest and healthiest sperm. The washed specimen is then placed directly into the wife's uterus. This procedure is carried out in the gynecologist's office. Because it is timed to the wife's cycle, it does not result in twins or triplets.
- Stimulated IUI—If artificial insemination fails, or the wife's cycles are not regular; the reproductive endocrinologist may decide to perform a stimulated insemination. This means that she will be started on Clomid or another drug to stimulate more eggs to ripen that month. This enhances the chance of success and can result in twins or triplets.
- IVF—When artificial insemination has failed, or the sperm counts are too low for successful insemination (most specialists look for 5 million total motile sperm for insemination) the couple may be directed to in vitro fertilization. This term is the same as "test tube baby" and refers to the fact that the fertilization occurs in the laboratory. The wife is stimulated with injections to make more eggs that month than usual. When her eggs are ripe, she undergoes a retrieval process that is performed with light sedation. The eggs are retrieved from her ovaries using an ultrasound probe.
On the same day, the husband is asked to collect a semen specimen, which will be washed. The sperm and egg are placed in a test tube and fertilization occurs over the next 24 hours. Fertilized eggs develop into embryos over the next 48 hours. Healthy embryos are then placed in the woman's uterus. A blood test and an ultrasound are used to confirm successful pregnancy.
- IVF with ICSI—When the sperm quality is very poor, or there are very few sperm to work with, IVF is combined with intracytoplasmic sperm injection (ICSI). This means that the process above is used. The only difference is that the sperm are assisted in the process of fertilization by being placed directly into the egg using a technique called micromanipulation. The IVF ICSI process has allowed couples with extremely severe male factor infertility to achieve pregnancies with near zero sperm counts.
Urology Associates, P.C. offers many of the above services in the office, several other tests and evaluations are done at outside laboratories and medical facilities.
For more information, or for an appointment, please call 516.627.6188, Extension 149
|
