About one in six couples trying to conceive a child experience infertility. Historically, physicians have looked at female infertility first, possibly even to the exclusion of male factors. However, male infertility plays a significant role for about half of infertile couples. About 30 percent of the time, the male factor alone causes infertility. About 20 percent of the time, it is a combination of male and female factors.
Spencer Land, M.D., urges couples to look into male infertility before rushing to try assisted reproductive techniques, since male infertility can be evaluated quickly and non-invasively. Land is a urologist and director of the division of male infertility and sexual health at Loyola University Health System (LUHS). He recommends a fertility evaluation sooner rather than later especially if the woman is more than 35 years of age or if either partner has had prior fertility problems.
"Treatment of the male problem may be more successful, less expensive and possibly less invasive than assisted reproductive technologies," Land said. "In addition, a small percentage of men who are infertile may have an underlying serious health problem, such as infection or cancer, that may jeopardize their lives."
Further, if the couple uses assisted reproduction treatments without a thorough evaluation of male fertility, the man may unknowingly pass a serious medical or congenital problem that affects fertility on to the child, such as cystic fibrosis, Kallman's syndrome or Y chromosomal-microdeletions.
The male fertility evaluation begins with a detailed questionnaire and discussion about the man's health and fertility history and sexual practices, followed by a physical exam, a semen analysis and blood work to assess the hormonal status.
The most common identifiable cause of male infertility - accounting for about 40 percent of cases - is varicocele, which means enlarged veins in the scrotum. The condition raises the temperature in the testes and harms sperm production. Varicocele can be observed during a physical exam and confirmed with an ultrasound exam. Men may feel a dull ache on the left side or both sides of the testes or no symptoms at all. Varicocele can be successfully corrected with an outpatient surgical procedure using an operating microscope and can improve sperm production dramatically.
Another cause of male infertility is a blockage of the reproductive tract. An obstruction keeps the sperm from getting out of the reproductive system. Blockages can be caused by infection or an anatomical problem or may be due to a prior vasectomy.
Vasectomy operations can be reversed successfully, even after decades. Land is trained in a surgical procedure called vasoepididymostemy, which may be needed for successful vasectomy reversal, especially those performed 10 or more years ago.
In some cases, production of sperm is the problem. Problems with sperm production may be caused by infectious disease, a hormonal disorder, an immunological disorder, environmental and lifestyle factors, or genetic disease. Medications, changes to lifestyle or reducing exposure to certain chemicals in the environment may be effective treatments.
One of the latest male infertility treatments is the microscopic retrieval of sperm from the testes when there is no sperm in the semen. It is possible & to conceive a child with only a single sperm. The sperm can be retrieved and the couple referred to an appropriate facility.
For more information about male infertility treatments at LUHS, call (708) 216-8563.
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