In today’s post, I continue my discussion of semen analysis for male factor infertility and also discuss treatment options for male infertility.
Overall, options to remedy sperm deficiencies range from simple lifestyle changes, hormonal pills, surgery, intrauterine insemination (IUI) or in vitro fertilization (IVF) along with intracytoplasmic sperm injection (ICSI).
Some abnormalities shown by a semen analysis can be corrected by simple lifestyle changes if indicated, such as:
- Weight loss
- Cessation of smoking
- Limiting alcohol intake
- Modifying lifestyle habits such as taking frequent hot-tub soaks
Other abnormalities may require more invasive intervention such as a varicocelectomy. Varicocelectomy is the tying off of a dilated vein (varicocele) near the testicles that can increase the temperature around the testicle and decrease sperm production. It is estimated that every two out of three men could see improvement in the sperm sample within 6 to 12 months of this type of surgery.
If the defect in the sperm analysis is very severe, then usually there is no efficient medical treatment. In some cases, there could be an obstruction of the ejaculatory path the sperm needs to travel (for example a vasectomy!). In other cases there could be just plain failure of sperm production, which is commonly seen in conjunction with a genetic abnormality. Cystic fibrosis, a relatively common genetic disorder, can cause the malformation of the tubes that carry sperm from the testicles to the urethra. Some features of the semen analysis together with a physical examination and measure of serum hormones and genetic markers can distinguish among these causes.
Do fertility drugs help male infertility?
Some deficiencies of sperm analysis, usually of the mild type, can be corrected by the use of fertility pills for men. In certain cases, a hormone pill called clomiphene citrate (Clomid) is prescribed to increase the sperm count and motility. It does not work for every case and in some cases it may take three to six months to see any noticeable effect of the hormone.
Do vitamins and supplements help male fertility?
It is generally believed that men should be taking a multivitamin daily which contains elements like zinc and selenium but there is no scientific proof that high dose vitamins or other over the counter fertility aids help improve semen quality.
Are there other treatments available for male factor infertility?
All medical treatment strategies are geared toward improving and increasing sperm production. A very large amount of sperm cells per ejaculate (>40 million) are needed for natural unassisted conception. If a man has a mild abnormality that could respond to clomiphene citrate treatment or a varicocelectomy, and the couple is willing to wait about six more months to see results, then this could improve semen from a subfertile to a fertile status. If improvement is not achieved, or if the man bypasses treatment because of urgency to conceive, then procedures such as intrauterine inseminations (IUI) can be performed at a fertility clinic.
How do IUI and IVF help for male factor infertility?
IUI is a technique where washed sperm, allowing for removal of slow or abnormal sperm, is injected softly into the uterus and fallopian tubes of the woman at precisely the time of ovulation. It is usually painless and takes less than 5 minutes to do. By contrast with natural conception, usually only 5 million or more sperm cells are enough to make an IUI successful.
If the sperm deficiency is severe enough to suspect that less than 5 million moving sperm cells could be collected for an IUI procedure then the best strategy is to use the help of assisted reproductive technology (ART) such as in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). ART requires even fewer sperm cells to be successful. ICSI, for example, requires only one viable sperm cell to be injected inside of the egg to fertilize it. Therefore, if a man produces sperm in a very limited amount he can still reproduce thru ART and IVF/ICSI. All of the above strategies have been deemed safe and effective and may be covered by insurance in certain states (New Jersey and Massachusetts for example). IUIs and ART procedures are done at fertility centers. It is best to work with a fertility specialist in conjunction with a urologist in a team approach to obtain the best care possible for the couple.
Dr. Marcus Jurema, fertility specialist at IVF New Jersey, received his medical degree from Stanford University School of Medicine and completed residency at The New York-Presbyterian Hospital, Weill Medical College of Cornell University, NY, NY. In 2003, he completed a fellowship in reproductive endocrinology and infertility at The Johns Hopkins Medical Institutions. After his fellowship, Dr. Jurema accepted an academic position at the Brown University Medical School as a Clinical Assistant Professor of Obstetrics and Gynecology, Division of Reproductive Medicine and Infertility of The Women and Infants’ Hospital of Rhode Island and became the Director of the Fertility Preservation Program and co-director of the Donor Egg Program. Areas of interest include the In Vitro Maturation (IVM) of Oocytes Program, a new technology allowing eggs to mature outside of the woman’s body, oocyte (egg) freezing, reproductive tract abnormalities, and improving IVF outcome for women with a low egg reserve.