Causes and Treatments of Infertility: Male Factors

Though many people assume that infertility is largely a female problem, the truth is that approximately half of infertility cases involve the male to some extent. The good news is that male infertility can be treated effectively in the overwhelming majority of cases.

The treatment of male factor infertility is one of the true success stories in the field of reproductive medicine. Sperm are the working reproductive cells that present a man’s DNA to the egg. In nature, the single sperm of the millions ejaculated that is most suitable to fertilize the egg is selected through a competitive process that is much like a race through an obstacle course. In the IVF lab, we initially assess a man’s fertility by measuring the numbers of sperm produced, assessing their ability to move effectively as well as judging their shape and size. Unlike in society, we like uniformity in sperm quality rather than individuality. Here’s where being average is the goal.

Disorders of sperm quality range from a low count or motility to a complete absence of sperm production. Deformities of the sperm cell shape (morphology) are important because they reflect its ability to fertilize the egg. Mild abnormalities of semen parameters can be effectively treated using techniques that “wash” away the seminal fluid to improve the concentration and selecting/isolating the normally-shaped motile sperm from the abnormal ones. This elite group of sperm can then be transferred to the uterus via an intrauterine insemination (IUI). However, for more severe degrees of male factor infertility, this treatment is inadequate. With a total motile cell concentration of less than 10 million cells per ml or a normal morphology of less than 4% “normal” by strict Kruger criteria, the chance of fertilization failure is very high, even with IVF. More targeted treatments for male infertility are based on its cause and/or severity:

Hormonal therapy (clomiphene, gonadotropins, corticosteroids, thyroid hormone)

Non-hormonal drug therapy (bromocryptine, antibiotics)

Surgery (varicocelectomy, vasectomy reversal, surgical treatment of undescended testes, etc.)

IVF-related procedures, i.e., intracytoplasmic sperm injection (ICSI) or testicular sperm extraction (TESE)

As a general principle, if the male factor cannot be reversed in the man’s body by simple medical or surgical treatment, then IVF with ICSI represents the only rational approach. Results are so high, some couples even choose this treatment mode instead of other medical or surgical treatments – even in those who are good candidates for these other treatments. Intrauterine insemination is not an effective way of treating moderate to severe male infertility.