The cornerstone evaluation for male infertility is the semen analysis. This is one of the most important fertility test for men because male infertility is present in up to 40% of couples with infertility.
• Male factor infertility is present in up to 40% of infertile couples
• It takes 72 days for a sperm cell to mature and become a part of an ejaculate. Different diseases, toxins, and vitamin deficiencies present 72 days ago will affect today's ejaculate.
• Prior surgery, like hernia repair or trauma to the testis, should be considered and investigated.
• Approximately 20% of the time sperm deficiencies are due to endocrine abnormalities, such as low testosterone. Other causes are genetic abnormalities, high prolactin hormone levels, or previous chemotherapy or radiation.
• A varicocele is a dilation of the major veins of the testicle, which may increase testicular temperature and lower sperm count leading to male infertility. Repair of a varicocele may improve sperm quality in approximately 50% of the patients but improvement may not be seen for 6 months. A varicocele can be detected with scrotal ultrasound.
• Certain medications can be toxic to sperm like narcotics, steroids, heat, alcohol, marijuana (both alcohol and marijuana reduce testosterone), or tobacco use. Prolonged hot tub use can damage sperm.
• Certain infections can impair the sperm's ability to penetrate the egg leading to infertility. Diseases including diabetes, mumps, and recent fever can also impair sperm. Men without sperm in their ejaculate can have an obstruction of the duct leading from the testis, or a problem with testicular production of sperm.
• Smoking can increase reactive oxygen species and decrease fertilization by 50%.
• Heavy smokers have increased cadmium toxicity in the testis.
• Any testosterone supplementation may impair male sperm production. Testosterone supplementation taken for prolonged periods may completely diminish sperm production causing azoospermia and return of normal sperm production may take years. Obesity is the leading cause of low testosterone levels in men as they have a higher conversion of their testosterone to estrogen.
• Many forms of male infertility can be treated, once the etiology (cause) is known.
• Intrauterine insemination is performed when the male has more than 5million sperm and is done by washing the sperm, concentrating it, and placing it inside the uterus using a small catheter.
• Men with sperm count of less than 5 million motile sperm would greatly benefit from
the process of in vitro fertilization with excellent pregnancy rates.
• Very low sperm count in the thousands or from sperm obtained from testicular extraction can achieve fertilization and pregnancy with in vitro fertilization and ICSI (Intracytoplasmic sperm injection).
• Azoospermia or lack of sperm in the semen analysis is usually treated surgically with
TESA (testicular sperm extraction) or MESA (epididymal sperm extraction)
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