Dr. William F. Ziegler
Dr. Jessica S. Mann
Dr. Alan M. Martinez
Male Factor Infertility… It Takes Two!
by Dr. Jessica S. Mann
For many years, infertility has been a problem attributed mostly to women. While the idea that women have a biological clock is unfortunately founded on good science, the extent of sperm abnormalities on pregnancy outcomes is currently under reevaluation.
Some cases of male infertility include low sperm count (oligospermia) and lack of any identifiable sperm (azoospermia). Urological evaluation allows identification of whether the problem is due to abnormal anatomy as in the case of a blockage, or because of suboptimal production of sperm as in a hormonal imbalance. In addition, a thorough male work up can identify conditions that can be passed on to the baby. Common anatomical conditions that can affect sperm counts include swollen veins around the testicles, a hernia or previous hernia repair, as well as obesity. Even though some anatomical conditions can be treated with surgery, others require that a single sperm be injected into a woman’s egg. The latter process involves in vitro fertilization. Hormonal conditions such as abnormal thyroid or low testosterone production may be treated with medications.
Other cases of male infertility can be attributed to poor movement (poor motility) or abnormally shaped sperm (poor morphology). These cases also deserve a thorough evaluation by a reproductive urologist. Recent studies have shown lower chances of pregnancy when there is a low proportion of normal sperm. Reports also suggest that abnormally shaped sperm may be associated with pregnancy loss. Due to conflicting data, the value of sperm degradation assays is limited. During the last meeting of the American Society of Reproductive Medicine, new technology has been proposed which can be used to pick better sperm for injection into an egg. Clearly, not all sperm are created equal. And not all embryos are created equal. Advances in our field allow us to test embryos prior to placing them into a woman’s uterus. In some cases, this technology can substantially improve the chance of a live birth. So for all couples struggling with infertility, don’t discount that there maybe a male factor issue at hand.