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Male infertility is present in up to 50% of couples. Infertility was once considered a "female problem" but we now know that male infertility is a major contributing factor in many couples. This incidence of male infertility makes the semen analysis one of the most important fertility tests, which should be performed prior to any female therapy. In general, men remain fertile for all of their adult lives whereas women experience an age related decline ending in the menopause.
"Male infertility" means that a man may not deliver either the appropriate quantity or quality of sperm that can reach and fertilize an egg. Sperm are "manufactured" in the testicles and travel through the epididymis and the vas deferens when ejaculated. Sperm require three months to develop which means a semen analysis done today is reflective of the conditions three months earlier. The conditions that originally caused male infertility may no longer be present.
 Male infertility can be caused by many factors. Sperm are sensitive to temperature and chronic exposure of the testicles to extreme heat can lead to sub fertility. Activities such as prolonged regular hot tube use can artificially raise the testicular temperature as can tight fitting clothing. Certain occupations, such as long distance driving, can also interfere with temperature regulation. Other occupations may cause exposure to spermatotoxic agents such as heavy metals. Any of the previous conditions can lead to male infertility especially if the cause is repetitive.
Male infertility can also be caused by a varicocele. A varicocele is a collection of dilated varicose veins in the spermatic cord. These veins carry blood away from the testicles performing a "cooling function". A varicocele can interfere with the normal blood flow and thus raise the testicular temperature leading to semen abnormalities, such as decreased count or motility. Although there is some debate as to whether or not varicoceles need to be repaired surgically, in general, the presence of moderate to severe varicoceles leading to an abnormal semen analysis would deserve serious consideration for surgical repair.
Male infertility may rarely be caused when a male develops antibodies to his own sperm causing an increased agglutination in the semen. This usually results after a trauma to the testicles or surgical procedures such as a vasectomy with reversal. When present, antisperm antibodies can bind to the sperm, essentially interfering with either fertilization or motility causing male infertility.
Male infertility cannot usually be treated effectively with fertility drugs. If a man is severely deficient in FSH and LH (hypogonadotropic hypogonadism), he can sometimes be treated with medications (Clomid, or gonadotropins). However, the treatments are very expensive and can take several months to be effective. Numerous products (including natural supplements), are advertised as being effective in improving sperm quality. Unfortunately many claims are made, but true benefits may be debatable. Clomid is usually not effective in treating other causes of male infertility.
Sometimes a man may seek reversal of a previous vasectomy. While reversal is often possible, a vasectomy should be considered a permanent method of birth control. Whether or not the tubes can be reconnected depends upon many factors including where and how the tubes were cut. Still, without a successful vasectomy reversal, sperm can be biopsied from either the epididymis or testicle for IVF (in vitro fertilization) with ICSI (intracytoplasmic sperm injection).
Moderate to severe male infertility can be treated using intracytoplasmic sperm injection (ICSI) which is an excellent option for many couples. In ICSI, a single sperm (collected by masturbation or biopsy) is injected directly into the egg. With ICSI it is even possible for a man with no sperm in his ejaculate to father a child. Sperm can be obtained directly from the reproductive tract using Testicular Sperm Aspiration (TESE -from the testes) or Microsurgical Epididymal Sperm Aspiration (MESA- from the epididymis).
Male infertility can be effectively treated with today's technologies allowing men to create genetically related children. Our Dallas, Texas IVF clinic offers superior success rates for IVF and IVF combined with ICSI.
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