Most causes of male infertility are very treatable
According to the CDC, (Center for Disease Control) one in eight couples or 7.4 million couples will have trouble getting pregnant in the United States. The Nevada Center For Reproductive Medicine estimates factors affecting men account for about half of the causes of infertility. Until recently, many of these couples were only able to become parents through the use of donor sperm or adoption. Fortunately, many forms of male infertility are treatable.
Brief History Of Male Infertility
During the 1950s and 1960s, techniques were developed to cleanse sperm from semen and capacitate them. This enabled couples to undergo intrauterine inseminations. In 1978, the first in-vitro fertilized (IVF) baby was born. IVF was designed primarily to help women with tubal factor infertility to become pregnant. It was finally in the early 1990’s, that techniques were created that helped men with very low sperm counts. The impact of these techniques on the treatment of male-related infertility is comparable to the impact antibiotics had on infectious disease 60 years ago.
Many factors can contribute to male factor infertility such as: hormonal imbalance, low sperm quality, poor sperm quality, poor progression (ability for sperm to reach the egg and allow fertilization to take place), erectile dysfunction, or blockage of the vas deferens where the complex process of spermatogenesis takes place. Male factor infertility can be very complex and sometimes unknown, through the use of male infertility testing, diagnosis and treatment many men are capable of overcoming infertility.
Why Are So Many Sperm Required For Conception To Occur?
The average ejaculate contains over 100 million sperm. Sperm must endure an extremely long journey from the vagina (after penile emission) through the cervix, and to the end of the fallopian tube where the mature egg capable of being fertilized resides. Fewer than one in a million sperm produced ever complete the journey.
Furthermore, the sperm must undergo a series of changes within the female reproductive tract before gaining full fertilizing capacity. These changes are known as maturation within the male tract and capacitation and the acrosome reaction in the female tract. The successful sperm not only must travel 100,000 times that of their size but has much to overcome in order to achieve fertilization.
The World Health Organization recommends there be a minimum of 20 million sperm available for effective conception to occur with intercourse. Male factor infertility occurs when the numbers are less than this.
Treatments For Male Infertility
The treatment for male factor infertility then is simply to help the sperm reach and fertilize the egg. If a lower number of available sperm is the problem, we can help this by decreasing the distance they must swim. Intrauterine insemination (IUI) places a sperm sample half way up the female reproductive tract
By cutting the distance, the minimum numbers required decrease substantially such that only about 10 million are desired for IUI and 1 – 2 million for IVF. These treatments have greatly reduced the threshold of sperm needed to achieve conception and have helped tens of thousands of couples worldwide to become parents.
In 1992, a revolutionary technique called intracytoplasmic sperm injection (ICSI) was first used to help four couples have babies. The technique uses micromanipulation so that a single sperm can be handled to fertilize a single egg. Thus, if a man produces any sperm, he is capable of becoming a genetic father.
Over the past five years, thousands of healthy babies have been born as a result of ICSI. And for the many men who have no sperm released, newer techniques of sperm retrieval have been developed to precede any obstruction. We can even take sperm directly from the testicle and apply ICSI to achieve conception. These newer techniques have an alphabet soup of acronyms: Percutaneous and Microsurgical Epididymal Sperm Aspiration (PESA and MESA), Testicular Sperm Extraction (TESE).
These techniques are commonly used for men who are born without a vas deferens or who have had vasectomies but later desire children. PESA and MESA allow men to avoid surgical reconstruction of the blocked vas and still maintain contraception after their baby is born. Finally, we have learned to identify viable sperm even if they do not move at all. No movement was the previous definition of a dead sperm, but with the hypoosmotic-swelling test (HOS) we can pick individual living sperm and apply ICSI to help these couples conceive.
There are treatments currently available to overcome many forms of male factor infertility. For the few men who never made or no longer make any viable sperm, the remaining options are to use donor sperm or adoption to become parents.
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