MALE INFERTILITY

Over 15% of couples experience difficulty in conceiving a child after attempting for one year. Although in the past infertility problems were attributed to the woman, we now know that a male factor plays a role in almost one half of cases. Since a male fertility problem is much more common that initially thought, any infertility evaluation should include a thorough male history and physical examination and two semen analyses. The optimal evaluation should recognize and treat the couple as a unit.

The male infertility evaluation begins with a complete fertility and medical history. Important information includes past pregnancies, febrile illnesses, history of mumps, undescended testicles, hernia repair, genital trauma, sexually transmitted diseases or urinary tract infections. A developmental and past sexual history with attention to onset of puberty and libido is elicited. Occupational, environmental and recreational factors such as high levels of stress, disturbances in the sleep cycle, drugs, smoking, excessive alcohol intake, lubricants, toxins, chemical or heat exposure, and prolonged use of a Jacuzzi or hot baths can all have a negative effect on fertility. A review of other medical problems, surgeries, prior and current medications and family history is obtained. Questions are asked regarding every organ system in the body to ensure that no undetected serious illness is responsible for infertility.

A complete physical examination is performed paying attention to male features such as hair distribution, breast size and the external genitalia. The scrotum and its contents are evaluated for the location, size and consistency of the the testicles, epididymis and vas deferens. The presence of a varicocele (dilated testicular veins), testicular masses, cysts and irregularities of the prostate are noted.

After the examination, a urine and semen sample is collected. A routine urinalysis and semen analysis is performed in our certified andrology laboratory. The semen analysis is reviewed with each patient on a monitor screen in the office. based on these results, blood tests or more specialized tests of the sperm may be recommended.

Once all the information is collected, the couple is given a presentation on male reproductive anatomy and physiology with particular attention to their specific problem. The nature of the problem, causes and treatment options are set forth. An opportunity for questions and discussion is welcome. We believe that couples need to be completely informed on all the currently available methods of conceiving a child, risks, potential complications, success rates and costs, so they can make a choice that is best suited for them.

Notice to Patients
In this new era of IVF, some gynecologists have begun treating both male and female infertility by using IVF only. In many instances the male partner’s condition is ignored and the male partner is not offered any evaluation or examination. In some instances gynecologists are even operating on male patients without having any formal training or certification.

We feel that this approach is dangerous for several reasons. First off, couples may not be informed of all their options so as to make an educated decision regarding their treatment. Secondly, male infertility is often the result of an underlying and usually treatable condition. Male fertility problems usually don’t arise without reason. In some cases male infertility is the first sign of testicular cancer and should not be neglected. For many couples, the problem can be corrected and expensive treatments can be avoided.

It is up to you, the patient, to make sure that the doctor treating you for male infertility is a board certified urologist with extra fellowship training in male reproductive medicine. In many instances the first shot at correcting the problem allows for the best chance of success and all patients deserve the best. If your doctor tells you something that doesn’t make sense, or gives no hope for the treatment of male factor infertility, then seek another opinion. We strongly believe that the best approach to infertility is a team approach with the male and female reproductive experts working side by side with the couple.

We hope you find the information presented interesting and useful, and we wish you the best of luck in reaching your goals and fulfilling your dreams.

Agglutinaton - Occurs when sperm clump or stick together. This may occur when either husband or wife develops immunity to the sperm. Can only be seen with a microscope.

Asthenospermia - A condition in which the sperm do not move (swim) at all or move more slowly than normal.

Azoospermia - A condition in which there are no sperm in the seminal fluid. This may be due to a blockage of transport of sperm or to an impairment of sperm production.

Congenital adrenal hyperplasia - A condition that is born with (congenital) due to the lack of an enzyme needed by the adrenal gland. Normal products of the adrenal gland, therefore, are not produced; the body tries to simulate the gland, and it enlarges (hyperplasia).

Cryptorchidism - Occurs when a testis is not in its normal position in the scrotum. It may be in the groin or abdomen.

Diabetes mellitus - Commonly referred to as "sugar diabetes." This is a condition in which the production of insulin by the pancreas is reduced or absent. It results in the elevated concentration of sugar in the blood and often urine. Patients with this condition may ultimately have nerve and circulatory problems.

Ejaculation - The ejaculatory process involves 2 distinct events: (1) emission (the deposition of seminal fluid components from vas deferens, seminal vesicle, and prostate gland into the posterior urethra) and (2) ejaculation (passage of this fluid through the urethra and explosion from the urethral opening).

Endrometriosis - The presence of endrometrial tissue (the normal uterine lining) in the abnormal locations, such as the tubes, ovaries and peritoneal cavity.

Genitourinary - Pertaining to the reproductive organs (genito-) and the urinary tract.

Gonadatropins - Hormones that are secreted by the pituitary gland in the brain act on the testicles (FSH, LH).

Hamster Test - A test of sperm function using specially processed hamster eggs and human sperm. The end result of the test or assay is the penetration of the egg by the sperm, i.e., sperm penetration assay (SPA). The egg is not fertilized but only penetrated.

Hematospermia - A condition in which blood appears in the semen and can usually be seen by the naked eye.

Hyperprolactinemia - The increased presence of prolactin in the circulating blood. This may be due to a benign tumor of the pituitary gland (prolactinemia) but is often due to the use of certain medications, e.g.; antihypertensive drugs or antidepressants.

Hypogonadotropic hypogonadism - That condition in men when low levels of gonadotropins (FSH, LH) result in lack of normal testicular function (hypogonadism). This hormone imbalance results in lack of normal masculinity and infertility.

Idiopathic Infertility - Occurs when a man has an abnormal semen analysis for which no reason can be found.

Impotence - The complete or partial inability to achieve an erection.

Necropermia - A condition in which sperm are produced and found in the semen but they are dead. These sperm cannot fertilize eggs. Sperm that are not moving are not always dead. Special stains have to be used to make this diagnosis.

Otiegospermia - A condition in which the number of sperm in a semen sample is abnormally low.

Oocyte - Egg, also referred to as an ovum.

Prostate - A gland found in males; it surrounds the urethra, near the bladder and produces fluid that contributes to seminal fluid.

Pyospermia - A condition in which the presence of white cells in the semen indicates possible infection and/ or inflammation.

Retrograde ejaculation - The explosion of seminal fluid backward into the bladder instead of forward through the urethra.

Semen, or seminal fluid - Composed of elements formed by the testes (sperm) and the male accessory glands (prostate and seminal vesicle). Only a small part of the visible ejaculate (semen) comes from the testicle.

Sperm - Exhibit several measurable characteristics:

Testicular failure - Occurs when the testes do not produce a normal number of mature sperm and when the hormones needed for normal sperm production (LH, FSH) are abnormally elevated.

Testicular torsion - A condition in which the testicle twists on itself, cutting off its own blood supply. It occurs most commonly in adolescents. Surgical correction is necessary as soon as possible to save the testicle. It is associated with excrutiating testicular pain.

Varicocele - A collection of vericose veins in the scrotum. Blood flows in an abnormal direction in these veins towards the testicle rather than the normal direction which is always towards the heart.

Vas Deferens - The long tube that transports sperm from the testicles to the urethra.

Vasography - An x-ray picture produced when x-ray dye is injected into the vas deferens. It is used to determine whether a blockage exists.

Viscosity - The thickness of the semen.