A recent article in The New York Times discussed the decline in male fertility rates in the US, Europe, Australia, and New Zealand over the past 40 years. Many factors have contributed to this decline including stress, pollution, pesticide contamination in food and water supplies, tobacco use, and other environmental factors. So, what does this mean when it comes to modern methods of male infertility evaluation and treatment? Does it mean that men have become a more prevalent source of fertility problems than women?
How Common is Male Infertility?
We find that many patients underestimate the prevalence of infertility problems in men. In reality, about half of infertility problems involve the male partner.
Though men often have the reputation of being the “silent partners” in infertility issues and treatment, we can attest that they have the same desire and longing for a family, and they experience the same feelings of loss, guilt, sadness, anxiety, and helplessness as their female partners. The traditional role of protector and provider weighs heavily on men when it comes to infertility, so being the cause of their partner’s inability to have a family can be emotionally overwhelming and emasculating.
So why do so many people still believe that infertility is largely a woman’s problem? Perhaps it is because women tend to be more proactive when it comes to seeking out solutions. Even when a man comes in for a semen analysis and male fertility evaluation, it is often the woman who schedules the appointment. But it is important to understand that as a rule, they are hurting emotionally – it is the dark secret of the male fertility experience. Often we find that they are not capable of describing or understanding their feelings, and their avoidance of the office is as much because of a desire to avoid the stigma and de-masculinization that comes with infertility. They don’t want to advocate for themselves, because that requires admitting that there is a problem. At Caperton Fertility, our goal is to demystify the infertility experience and to be as supportive of them as we are of the female patient.
What Are the Types of Male Infertility?
Male infertility involves problems with the sperm and its access to the egg – the amount (count), the quality, the shape, the mobility/movement (motility), or the sperm’s ability to get from the testicle to the egg – including the transport out of the testicle. This encompasses all types of sperm quality and quantity issues as well as erectile dysfunction, impotence, and injury to the testicle(s), obstructions or absent vas deferens, or other occlusive abnormalities in the testicle, vas, prostate or seminal vesicle.
There are also a number neurological abnormalities that can affect the ability of the sperm to make it out of the testicle. These include retrograde ejaculation, where the sperm passes to the bladder rather than through the urethra, and other injuries and disease that can affect the sphincter near the bladder and hinder ejaculation including spinal cord injuries, diabetes, and previous surgeries.
There are a number of genetic and congenital conditions that can cause the inability to produce viable sperm. These include undescended testes and genetic abnormalities in the male such as SRY micro-deletions, Cystic Fibrosis, and problems that affect the chromosomal integrity of the sperm such as Klinefelter’s Syndrome (XXY sex chromosome configuration in the male, which causes all of his sperm to carry this combination).
Another fairly common condition in men is a varicocele – a varicose vein in the scrotum. A varicocele can raise the temperature in the scrotum, which may contribute to sperm quality and quantity problems in some men. There is some debate as to whether varicoceles have any noticeable impact on sperm quality. The answer is…we don’t know for sure. Varicoceles tend to be more common in infertile men, but they don’t always seem to affect sperm quality. We can treat varicoceles to remove another potential barrier to fertility.
How Does the Sperm Get to the Egg?
The sperm has a perilous journey against often hostile conditions where only the strongest and healthiest sperm can finish. It is truly a miracle that fertilization ever occurs naturally, given the difficult path that the sperm must traverse and the work required to even penetrate into the egg. The sperm must first navigate and survive the low pH environment in the vagina, then pass through the mucous and tortuosity of the cervix, finding its way through the uterus and out the Fallopian tubes. If it makes it this far, it then undertakes the ‘ten mile swim’ down the Fallopian tube to reach the egg, where it now competes with perhaps several thousand other sperm to corkscrew its way into the egg and then to unpack its DNA and deliver it to the egg to work with.
What Are the Treatment Options for Male Infertility?
The role of the man in reproduction is often overshadowed by the role of the woman, but his contribution is just as important, as witnessed by the fact that about half of infertility problems stem from the male.
The good news is that the treatment options for male infertility issues generally have extremely high success rates. Problems with count, motility and morphology can be overcome through a procedure known as Intracytoplasmic Sperm Injection (ICSI). Through another miracle of modern reproductive medicine, we can take a single sperm and, using a powerful microscope and special equipment, inject it into the egg to initiate fertilization. This has been a major breakthrough in male infertility treatment with successful fertilization in close to 90% in the procedures we perform at Caperton Fertility Institute.
When a man has no sperm present in the ejaculate – or isn’t able to ejaculate, we can perform a minor surgical procedure known as TESE – Testicular Sperm Extraction, in the comfortable environment of our own lab to extract sperm directly from the testicle. All we need is a couple of sperm to make it work. We can then fertilize the eggs with this sperm via ICSI as mentioned above.
This is one of the modern male infertility success stories. What used to be a situation where donor sperm was the only solution for many male fertility issues, we can now go straight to the source, find the sperm and inject it directly into the egg. Using ICSI, pregnancy rates with IVF are essentially the same for men with severe sperm abnormalities as they are in men with normal sperm parameters.
Since the advent of ICSI approximately 30 years ago, there hasn’t been a great deal of research into men’s fertility issues, largely because the National Institutes of Health ceased providing grants for the study of male reproduction until just a few years ago. This is another reason that male infertility problems may seem to be overshadowed by issues on the female side of reproduction.
If it is discovered that a man ultimately does not have any viable sperm, we do provide access to donor sperm programs as well as genetically tested embryos that have been donated by couples who have finished prior treatment and now wish to donate their embryos rather than discard them.
Can Supplements and Vitamins Be Used to Improve Sperm Quality?
You may have heard that certain types of nutritional supplements can improve sperm quality. There have been studies done that involve a regimen of antioxidants including L-carnitine, vitamin C, coenzyme Q10, vitamin E, vitamin B9, vitamin B12, zinc and selenium. The study concluded that the treatment regimen “significantly improved key sperm parameters in 20 men diagnosed with asthenoteratozoospermia (sperm with a low motility and abnormal morphology). In addition, the supplement helped reduce sperm DNA fragmentation (SDF) and the amount of sperm with high levels of DNA degraded sperm (DSS).” As with other types of treatment with anecdotal success reports, we don’t rely on these as a primary course of treatment, but we are strong advocates of a holistic approach to fertility optimization. There is increasing evidence that a healthy lifestyle and the avoidance of environmental toxins MAY be important in optimizing fertility potential. Accordingly, we encourage our patients to exercise, avoid smoking, limit caffeine and alcohol intake, avoid heavy metals, hydrocarbons, heated plastics, and pesticides when possible.
How Successful is Intrauterine Insemination for Male Infertility
Because the large majority of male factor infertility issues involve abnormalities in the sperm that hinder the natural process by which the sperm reach and penetrate the egg, IUI (artificial insemination) has extremely low success rates in these cases. Though exact success rates are dependent upon age and diagnosis, they generally range from a 1% per month to 8-10% per month. These statistics have not changed notably in several decades. On the other hand, success rates for IVF with ICSI have been increasing exponentially. Almost without exception, IVF offers a much higher chance of success than IUI in male factor infertility cases.
How Do I Interpret Semen Analysis Results?
The basic test of male fertility is the semen analysis. This is a simple test that involves producing a sperm sample that is then analyzed for a number of factors including volume, shape (morphology), movement/speed (motility) and the number of sperm in a single ejaculate (count). There are parameters that we use to analyze whether a man’s semen is within a “normal” range and determine whether the male partner may be contributing to the couple’s conception problems.
Caperton Fertility Institute has extensive experience and expertise in testing, diagnosing and treating male fertility issues as part of our personalized and integrated approach to fertility care. We never treat just one partner in isolation. Rather, we perform a comprehensive series of diagnostic tests and procedures on both partners to make sure that we are fully addressing all fertility issues and optimizing a couple’s odds of conceiving and delivering a healthy baby. And for continuity of care, we try to keep all of the diagnostic testing and treatment for male infertility in the comfort and familiarity of our offices, rather than referring you out to multiple clinics and labs for your testing and treatment.