What is the male infertility?
Male Infertility refers to any disease that adversely affects men’s possibilities to initiate pregnancy. The most common cause for these problems is when a man produces poorly-developed sperm or, in severe situations, no sperm at all.
Infertility affects 10-20% of couples of childbearing age. The cause is usually in a 40% male, 40% female and 20% both, or unknown. In this field we offer the following coverages:
- Diagnosis of the infertile male:
- Physical examination
- Semen analysis (seminogram)
- Hormonal profile
- Genetic analysis. Karyotype
- Transrectal Ultrasound of seminal vesicles
- Doppler ultrasound of the scrotum
- Surgical treatment:
- Microsurgical correction of varicocele
- Testicular biopsy with microaspiracion and seminal cryopreservation (Coordination with the service of Assisted Reproduction) for realization of ICSI (intracytoplasmic sperm injection)
- Microsurgical techniques of reversal of vasectomy (vaso-vasostomy, epididymis-vasostomy and tubule-vasostomy)
- Transurethral resection of the ejaculatory ducts
Infertility is a common but complex problem that affects approximately 15% of couples trying to have children. For over 50% of couples who have difficulties getting pregnant, the problem is at least in part related to reproductive issues of the man. It is crucial that men seek assistance to determine the treatable and non-treatable causes of this disease.
Fortunately, with the current high-technology procedures and drugs available, an infertility diagnosis may simply mean that the road toward fatherhood is a challenge but not an impossibility.
What causes male infertility?
The doctor will ask about any factor, including possible structural defects or of other nature in the reproductive system, hormonal deficiencies, illness and even any trauma that may be affecting your fertility. Research will focus on the largest possible combination of factors, among which the most common are:
- Disorders of the sperm: the problems with the development and production of spermatozoa are the most common male infertility. The sperm may not be fully developed; it may have an abnormal shape or be unable to move. Or, it may happen that the produced sperm are normal but that the amount produced is not sufficient (oligospermia) or that they are not produced at all (azoospermia).
- Varicocele: these are dilated scrotal veins that are present in a 16% of men but they are more common in infertile men (40%). They inhibit the development of spermatogonial cells because they prevent an adequate flow of blood. Varicoceles are easily detectable with a physical examination, since the veins are appear at touch as a bag of worms. They can also be large enough and twisted as to be visible in the scrotum. This is the most common correctable cause of male infertility.
- Retrograde ejaculation
- Immune Infertility: it is caused by the immune response of man to his own sperm, the antibodies are usually the result of injury, surgery or infections.
- Obstruction: obstructions block the passage of sperm and may be due to a variety of factors, such as repeated infections, previous surgery, inflammation, or other problems of development. Any portion of the male reproductive tract, such as the vas deferens or epididymis, can be blocked and thus avoids the normal transport of sperm from the testicles to the urethra, where it exits the body during ejaculation.
- Hormone therapy: responsible for stimulating the testicles to produce sperm cells, hormones from the pituitary gland play a very important part in fertility. Therefore, when the hormone levels are extremely low, the result can be a low sperm development.
- Genetics: genetics has a central place in fertility. The presence of abnormalities in the amount of chromosomes and in their structure, as well as missing parts in the important Y chromosome present in normal men, can also have an impact on fertility.
How is male infertility diagnosed?
The process begins with a complete medical history and physical examination, and continues normally with blood and semen (seminogram) analysis. From a sample of semen, your doctor will be able to evaluate factors – volume, number, concentration, movement and even structure – that can facilitate or prevent conception. If the semen analysis presents low levels, or even the absence of sperm, this does not necessarily indicate absolute infertility. It may be necessary to perform a testicular biopsy when the semen analysis is abnormal and the doctor still cannot determine the cause. This study is performed in an operating room under general or regional anaesthesia via a small cut in the scrotum. A small piece of tissue is removed from each testicle for evaluation under the microscope.
In addition to the semen analysis, the doctor may request a hormonal profile to determine the production capacity of the testicles and to rule out serious diseases. For example, the follicle stimulating hormone (FSH) is the pituitary hormone responsible for stimulating the testicles to produce sperm. The presence of high levels may indicate that the pituitary gland is trying to stimulate the testicles to produce sperm and that these are not responding.
What is the treatment for male infertility?
The treatment of male infertility will depend on the specific problem. In severe cases there is no treatment available. However, in many cases, a combination of medications, surgical approaches and techniques of assisted reproductive technology (ART) that can be used to overcome many of the underlying fertility problems. The options are:
- Surgery: repairing dilated scrotal veins (varicocele) is generally achieved by the use of a minor surgery (microsurgical varicocelectomy) without the need for hospitalization (USDS). There are studies that show that the repairing these veins improves sperm movement, as well as their concentration and structure. In some cases, the obstruction that generates infertility can also be corrected surgically.
- Medications: while drugs are a key resource to correct the retrograde ejaculation and immunological infertility, hormonal treatment with drugs such as clomiphene or gonadotropins can help correct endocrine imbalances.
If these techniques fail, fertility specialists can draw upon a variety of other high-technology techniques of assisted reproduction that achieve conception without relation. Depending on the problem, your doctor may consider:
- Intrauterine Insemination (IUI)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)