Sadly, in spite of major advances in the treatment of infertility, one the biggest challenges that remains is the reluctance on the part of many men to confront their role in the infertility equation. It is still somewhat common to have a woman arrive for an infertility consultation without her partner. Thus, at this time of “Men’s Health Month”, it is appropriate to make men aware of the indispensible nature of their contribution to, and participation in the evaluation and management of infertility.

One third of infertility is due to the man, one third the woman and the remaining third, a combination of both partners. With male factor infertility playing such a large role and about 10% of men having some degree of sperm dysfunction, the unwillingness on the part of many men to step up to the plate and confront their role in this equation is a matter of concern. Perhaps this reluctance to confront their reduced procreative ability is centered on an ill-conceived notion that male infertility equates with reduced virility. This is certainly not helped any by the fact that most reproductive research has in the past been conducted by men.

It was not until the last quarter of the 20th century that significant scientific attention was paid to the evaluation and treatment of the infertile male. Not only was the understanding of male infertility poor, but to make matters worse, there was no reliable treatment available. Procedures such as artificial insemination (intrauterine insemination or IUI) hardly improved success rates, (especially when used in cases of moderate or severe male infertility), surgeries such as varicocelectomy to remove a collection of varicose veins around the testicles was rarely of benefit and the use of fertility drugs to enhance the production of sperm was poorly understood and thus mostly futile.

Then came the introduction of In Vitro Fertilization (IVF) and with it, a new found ability to successfully treat several, hitherto intractable causes of female infertility (tubal blockage and severe endometriosis, etc.). IVF sparked a hope that it would also benefit treatment of male factor infertility. Alas, this was not to be, because the same factors that prevented sperm from fertilizing an egg in the woman’s body similarly compromised the process of fertilization in a Petri dish.

But all this was soon to change. The advent in the early 90’s of Intracytoplasmic Sperm Injection or ICSI which involves the injection of a single sperm directly into each egg to fertilize it, was to revolutionize the treatment of male infertility. ICSI soon found its rightful place in the growing infertility therapeutic armamentarium… to the point that today, this approach is used with considerable success to treat more than 90% of male infertility. What is more, reported pregnancy rates achieved by this method of fertilization are as high as those obtained using conventional IVF performed in cases of non-male-factor infertility.

There have also been major advances in the ability to enhance sperm production through the use of selective therapies in men with reduced sperm function due to hormonal factors. In addition, the use of antioxidant and vitamin therapies with male fertility blends such as ProXeed or Proceptin have been shown to improve sperm function in certain cases. Additionally, surgical removal of early spermatozoa from the testicle – called Testicular Sperm Extraction or TESE (with subsequent performance of ICSI) has assisted in achieving success in men who are not capable of ejaculating any sperm at all.

The first step in addressing male infertility is to obtain a detailed history and then to perform a basic computerized semen analysis so as to assess sperm structure and function. From the history, factors that might have compromised testicular sperm production can often be identified. Relatively common causes of the latter include failure of both testicles to have descended into the scrotum at the time of birth, childhood testicular infection with viruses such as mumps, testicular trauma or injury during childhood or early adulthood, exposure to radiation or chemotherapy for cancer, and toxicity from heavy metals such as lead or mercury that could injure the sperm bearing tissue in the testicles.

Then there are those cases where the man’s brain and the pituitary gland (a small gland that hangs beneath its base) fail to adequately stimulate the testicles to produce sperm. In most such cases, the diagnosis can be made by testing blood levels of testosterone, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). In some cases, the underproduction of FSH and LH will be apparent and readily amenable to treatment with medications that reverse this effect. In other cases, a high concentration of these hormones will point to (usually) irreversible, permanent damage.

It remains a fact that unless moderate or severe male infertility can be reversed through simple medical or surgical intervention, treatment will be unsuccessful without access to In Vitro Fertilization (IVF) with ICSI. Perhaps this post will help persuade men to take a more active role in the evaluation of infertility.

For those men/couples who have not been evaluated for male factor issues, SIRM is now offering a free semen analysis at any of our offices. I encourage you to contact your nearest SIRM office to take advantage of it.