Its Evaluation and Management—What You Need To Know
It is a fact: At least fifteen percent of all couples have difficulty initiating a pregnancy.
It is also a fact: 50% of the time a male factor is involved. 70% of the time a female factor is involved; therefore, a significant number of infertile unions involve both a male and female factor.
When should a couple
be evaluated?
Most agree, about 85% of couples will establish a pregnancy after
trying for one year. There are circumstances, however, when an evaluation
should be initiated sooner, such as when one partner has a known
risk factor for infertility.
What made the 1990's
a turning point in the treatment of male infertility?
The 1990's have witnessed an explosion in the field of infertility
treatment. New tests of sperm morphology and function have been
developed. 1992 marked the first successful pregnancy with intracytoplasmic
injection of sperm (ICSI) into eggs in an in vitro fertilization
cycle. The development of new microsurgical techniques are enabling
vasectomy reversals to be performed with a high success rate. Men
previously considered infertile are now fathering children.
Why should a man be
evaluated if all that are necessary are a few sperm to fertilize
an egg?
A man is more than just a sperm donor, he is a patient. He requires
an evaluation to determine if there is any identifiable cause for
the problem. If one is identified, a treatment may be available
to allow the male to father several natural pregnancies. A male
needs his own doctor, to render appropriate counseling, advice and
therapy. A physician who treats male infertility should have special
focused training in that area.
What does a male factor
evaluation entail?
First, I always request that the female partner is also evaluated,
preferably by a specialist in female infertility (a reproductive
endocrinologist) since in a significant number of couples, there
may be both a male and a female factor.
Second, I prefer if both the man and woman come to the office on at least the first visit. It is a chance for both partners to work together in the process and to discuss realistic expectations and possible therapies.
The evaluation begins with a medical history. Within this history, specific risk factors are identified such as history of testicular trauma, or genitourinary infection. A reproductive history is also obtained.
Next, a physical examination is performed. This examination places emphasis on inspection of the genitalia, especially the testicles.
Finally routine laboratory testing is performed. This includes certain blood hormone levels and 2 routine semen analyses. The semen analysis remains a cornerstone of the evaluation of the male and gives information on the sperm count, the motility, and the morphology or shape of the sperm.
Sometimes additional testing is necessary. Examples of this include a sperm penetration assay (a test of sperm function), scrotal ultrasound (a method to inspect the testicle, epididymis and spermatic cord for abnormalities) and testicular biopsy (method to determine the quality of sperm production by the testicle).
Treatment:
Generally, two office visits are needed to determine the most appropriate
treatment. Treatment can be either medical or surgical depending
on the nature of the problem. Proper diagnosis and treatment can
often lead to lasting improvements in fertility an allow the natural
conception and delivery of one or several healthy babies.