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10 facts on male infertility treatment and causes

male infertility treatmentIt is now well established that of infertility problems in couples, the female partner accounts for 40%, males account for 40%, and both account for the remaining 20%. It is therefore important that couples who are having trouble getting pregnant understand both male and female factor infertility. Below are some of the most important facts to know about male infertility treatment, diagnosis, and causes.

  • Males should be evaluated at the beginning of an assessment of an infertile couple because conditions causing infertility or other significant illnesses can be detected at that time.

    1. The major causes of male infertility include:

      • varicocele,
      • infection,
      • congenital and acquired obstruction,
      • hormone disorders,
      • genetics,
      • testis and other cancers,
      • cancer therapies,
      • erectile and ejaculatory dysfunction,
      • recreational and prescribed drugs, and
      • environmental toxins.
    2. Medical examination can lead to detection of significant medical problems. A 2002 study (Kessler and Honig) reported a 15% rate of testis cancer in men with no sperm in the ejaculate (secondary azoospermia). The expected incidence of testis cancer is 2.3/100,000.

    3. The good news is that currently we are able to help most patients with male factor infertility. In fact, we now routinely are able to help achieve pregnancy in couples where the wife makes more eggs than the husband sperm! Since 1992, it has been possible to achieve pregnancy with a single sperm using a technique called intracytoplasmic sperm injection (ICSI). Using a micromanipulator, a single sperm can be injected into a egg with excellent pregnancy rates! This of course requires in vitro fertilization to retrieve the eggs from the female partner.

    4. Even couples where the husbands sperm count is zero (azoospermia) can now achieve pregnancy. This is achieved by aspirating sperm directly from the testis (or epididymis) using a needle (testicular sperm aspiration or TESA). A microscope can also be used to aspirate the sperm (MICROTESA). Testicular sperm is immature and unable to fertilize eggs on its own. The eggs are therefore fertilized with the testicular sperm using ICSI. Once again, excellent pregnancy rates have been reported with this technique.

    5. Donor sperm is now used only in couples where there are no sperm aspirated with TESA. Other indications for using donor sperm include prevention of genetic diseases, single female etc.

    6. Improvement of lifestyle is probably the most effective treatment to improve semen parameters. These have been discussed in a previous blog.

    7. Use of anti-oxidants (Co-Q 10 or its metabolite Ubequinol), Vitamin C (500 mg daily of its esterified form) can be useful.

    8. If hormonal imbalance is present, then there are medications that can improve sperm count. E.g. if the testosterone level is low, treatment with clomiphene citrate (25 mg daily for 3 months) may help. If the estradiol level is elevated, then an aromatase inhibitor like Arimedex may help.

    9. Consultation with an urologist specializing in male infertility is an important first step. An urologist can help detect testis and prostate cancers, retrograde ejaculation caused by diabetes, erectile dysfunction caused by hormonal imbalance (testosterone deficiency or hyperprolactinemia), and fertility problems or infertility caused by genetic disorders (i.e., Klinefelter’s syndrome, cystic fibrosis, Y chromosome microdeletion, hypo- gonadotropic hypogonadism, and Kallmann’s syndrome).

    10. Men with testis cancer often have an abnormal semen analysis. The incidence of testis cancer was found to be 20 times higher in infertile men with an abnormal semen analysis compared to the general population. Erectile dysfunction in young men might predict later onset of coronary artery and other vascular diseases and also might serve as the first sign of diabetes. It is now possible to store sperm prior to cancer treatment. Cancer specialists should be educated on the need to counsel their male patients on sperm storage and cryopreservation prior to cancer treatment (fertility preservation).

    To see a fertility specialist who is qualified and experienced in urological consultation, make an appointment at one of our four convenient Chicagoland locations. Our physicians include Robert Brannigan, M.D., who heads the male infertility division at Northwestern University Hospital.


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Patty Paganucci

Patty Paganucci

Patty has worked for InVia fertility Specialists since its inception in 2002. She has 16 years experience in her field. She has an Associate's Degree in Nursing. She is our phlebotomist at our Hoffman Estates office. She also is our surgical coordiator


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