Medical contribution by Lauren Roth, M.D.
Lauren Roth, M.D., is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. She has published research on a range of fertility topics including polycystic ovary syndrome (PCOS) and the impact of weight on reproductive hormones. Dr. Roth sees patients in SGF’s Frederick and Rockville, Maryland offices.
Overcoming male factor infertility is possible through the right diagnostic testing and appropriate treatment protocols. While the infertility conversation often revolves around the female partner, the male partner’s role is just as important. Infertility is often seen as a female problem, but surprisingly, 40 percent of cases are attributed to the male partner, with an additional 10 percent coming from a combination of the male and female partner.
The large occurrence of male factor infertility makes testing fundamental to obtaining an accurate diagnosis and designing an appropriate treatment protocol. The good news is that testing at a qualified laboratory that uses strict semen analysis parameters can provide patients with an accurate picture of the male partner’s fertility status.
If your physician diagnoses male factor infertility, there are many treatment options. Here are the three basic steps to diagnose, improve, and overcome male factor infertility.
Step 1: Does he have strong swimmers?
In normal reproduction, one sperm must be healthy enough to go the distance to fertilize the egg. This means the very first step in diagnosing male factor infertility is to assess the overall fertility potential of the male partner’s sperm. Fertility treatment should never be initiated without completion of this step. It is important to understand that the parameters laboratories use to judge the quality of sperm can drastically vary.
“Frequently, patients will come to us with a normal semen analysis and upon re-evaluation we find that the results are not accurate and male factor infertility is present after all,” explains Firoozeh Naeemi, andrology laboratory supervisor at Shady Grove Fertility. There are several factors that may impact test results when using an outside laboratory:
- Wait time between collection and testing: Shady Grove Fertility analyzes soon after receipt of the sample, whereas other laboratories may take up to 24 hours. This delay can considerably compromise the integrity of the sample.
- Computer-Assisted Semen Analysis (CASA) versus an andrologist: Some labs use computer technology instead of an andrologist to visualize and interpret the sample. Shady Grove Fertility has found the human eye is more accurate and objective when assessing the sperm sample, resulting in more reliable test results.
- Training and experience: Shady Grove Fertility’s Andrology Team is dedicated solely to the analysis of sperm. Their experience, along with specialized training, makes them experts in the field and produces more accurate test results.
Shady Grove Fertility follows the World Health Organization’s (WHO) recommendation for analyzing sperm. One of our twenty specialty-trained andrologists visually evaluates each sample. He/she is looking for:
- Volume of the ejaculate
- Sperm count
- Motility (movement)
- Morphology (shape)
This disciplined approach to semen analysis testing provides each patient with accurate test results within 48 hours.
Step 2: Naturally improve the quality of your semen
Frequently, lifestyle factors can impact the condition of sperm. A man can make small changes immediately to naturally improve sperm quality and quantity. Our physicians suggest the following tips to help improve sperm quality:
- Lose weight and exercise
- Maintain a healthy diet with foods rich in antioxidants
- Don’t smoke or use recreational drugs
- Reduce your intake of alcohol to fewer than 5 drinks per week
- Take a daily multivitamin
Semen is continuously being produced in the male body, and takes approximately 74 days to mature, meaning that positive lifestyle changes today can result in improvements in sperm quantity and/or quality in as little as 2 to 3 months time.
Further evaluation may be required based on the abnormality of the semen analysis. We recommended patients receive further evaluation with our in-house fertility urologists, Paul Shin, M.D., Cori Tanrikut, M.D., and Russell Hayden, M.D., to determine if there are other underlying issues (hormonal imbalances, anatomic or genetic conditions) that may be contributing to the results.
Step 3: Fertility options that work
A man can overcome male factor infertility with a variety of treatment options. A diagnosis of male factor infertility is categorized as mild, moderate, or severe. The goal with any treatment is to get the sperm as close to the egg as possible. The severity of the case, the fertility status of the female partner, and comfort level of the couple together dictate the planned course of treatment.
For milder cases, many patients find success with intrauterine insemination (IUI), a low-tech treatment option. Prior to the insemination, the man will collect the sperm and an andrologist will “wash” the sample. The washing process separates debris from the healthy sperm, creating a concentrated semen sample. Upon insemination, the physician will place the washed sperm into your uterus through a soft, thin catheter. This method places the sperm in very close proximity to one or two eggs that have been released through the natural process of ovulation.
A fertility specialist can successfully treat moderate cases of male factor with IUI but, if unsuccessful, in vitro fertilization (IVF) is very effective. The benefit of IVF is that sperm have more available eggs to fertilize. Once the physician retrieves the eggs from the woman, an embryologist places them in a Petri dish in the laboratory. He/she will place a concentrated amount of sperm directly onto the eggs and monitor closely for fertilization.
Moderate and severe cases may also use IVF treatment with the addition of intracytoplasmic sperm injection (ICSI). Instead of positioning the sperm close to the eggs in the Petri dish, the embryologist actually selects a single sperm and injects it directly into the center of an egg. An embryologist then monitors each egg for signs of fertilization and embryo development. ICSI is an extremely effective technique for overcoming male infertility.
Between 40 to 50 percent of infertile couples experience a form of male factor infertility. Luckily, this form of infertility is easily overcome with the right diagnosis, lifestyle choices, and treatment.
Learn more about Male Factor Infertility with our On-Demand Webinar.
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Editors Note: This post was originally published in April 2013 and has been updated for accuracy and comprehensiveness as of June 2021.