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Male Factor infertility
What is infertility?
Infertility is defined as the inability of a couple to achieve pregnancy after a year of regular, unprotected intercourse (six months if the women is over 35), or the inability of a woman to carry a pregnancy to live birth.
Is infertility primarily a woman’s problem?
No. Male factors and female factors each account for about a third of infertility problems. The remaining third are either a combination of male and female factors or are unexplained.
How is a male infertility problem diagnosed?
The typical infertility work-up includes three elements:
Medical history, physical exam, and laboratory testing.
· Medical History: Your doctor will probably ask about timing and frequency of intercourse, use of lubricants that can damage sperm, past sexually transmitted diseases that may have damaged the reproductive tract, illnesses such as mumps or diabetes, use of medications or recreational drugs, exposure to chemicals or radiation, and exposure to heat sources such as hot tubs or saunas.
· Physical exam: Your doctor will check the size and firmness of the testes, and look for any obstructions of the reproductive tract. The scrotum is checked for varioceles, which are varicose veins in the scrotum that affect about 40% of infertile men. The exam may also include examination of the prostate gland and seminal vesicles.
· Laboratory testing: Your doctor will conduct a semen analysis, which measures the number of sperm (sperm count), their shape and size (morphology), their motility, and semen volume. Sperm motility has been found to be one of the most important factors in determining the fertilizing capacity of sperm. Because sperm counts and quantity can vary, at least two or three samples will usually be taken. A semen sample reflects what went on in the body 60 – 72 days earlier, when the sperm were forming.
· Other laboratory tests may include measurement of hormone levels, an antisperm antibody test (which can reveal the presence of protein molecules that interfere with sperm’s ability to fertilize an egg), a white blood cell test (which can reveal infection), and a urinanalysis (which can reveal retrograde ejaculation if sperm are detected in urine).
What treatment options are available?
· Surgery can often correct varioceles or blockages of the reproductive tract. When a blockage or other reproductive tract problem cannot be corrected, sperm may be extracted from the epididmis or testicles. This procedure is usually performed by a urologist.
· Medications can be used to treat hormonal imbalances, antisperm antibodies, or infections.
· Insemination, which involves placing sperm directly into a woman’s vagina with a catheter, can overcome mild sperm abnormalities.
· Assisted reproductive technologies such as in vitro fertilization (IVF), in which egg and sperm are united in a laboratory and transferred back to a woman’s uterus, are used in about 5% of cases.
· Intracytoplasmic Sperm Injection (ICSI), which involves injecting a single sperm into an egg, may provide men who produce very low amounts of weak sperm a chance to establish a pregnancy. The sperm used for ICSI can be obtained by masturbation or directly from the testes.
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