The following information is for educational purposes only. We do not diagnose or treat the underlying cause of male infertility. This is typically done by an urologist. However, treatment such as inseminations or in vitro fertilization are often effective in couples.
Infertility was once considered a “female problem” but we now know that male infertility is common. Some degree of male infertility is present in up to half of infertile couples. While certain exceptions exist, no significant treatment of the female should begin until male infertility has been excluded.
The semen analysis is a basic fertility test that assesses sperm quality and quantity. Sperm require three months to develop so a sample taken today is reflective of conditions three months prior, which might have changed.
A normal semen analysis has the following characteristics:
Unlike females whose fertility declines with age, most males retain fertility throughout their lifetimes. Male infertility occurs when quality sperm cannot be produced and ejaculated into the vagina, swim through the cervix into the uterus, and be present in sufficient quantity to initiate fertilization and subsequent pregnancy.
When sperm counts are mild or moderately severe, simple infertility treatments such as IUI can be successful. IVF success rates are generally higher than those associated with an IUI, and are definitely a better choice when severe male infertility exists.
Unfortunately, there are no proven medical treatments for male infertility except in rare cases of hormonal deficiency. Even these cases require three months of therapy, which is expensive. Many male fertility enhancement products are promoted, especially on the Internet, but they lack a consensus of clinical studies documenting their effectiveness.
Some men who have had a vasectomy seek to have the procedure reversed. This is often due to a new relationship or simply regret of limiting his family size. A vasectomy reversal can be very effective, but works best when it is reversed in the first several years after the vasectomy.
The longer the duration of the vasectomy, the lower the expectations of seeing a return of sperm in the ejaculate that can result in a pregnancy. As a result, for couples contemplating a vasectomy, it may be a consideration to cryopreserve (freeze) some sperm in case a future prospective vasectomy reversal is unsuccessful.
When men have undergone a vasectomy reversal and sperm counts are extremely low, in vitro fertilization (IVF) can be very successful, especially when used in conjunction with intracytoplasmic sperm injection (ICSI).
This is a process where individual sperm are injected into individual eggs. It should be noted that an alternative to a vasectomy reversal exists whereby sperm are extracted from the male reproductive tract by a needle or operative procedure and frozen.
This allows the sperm to be utilized at a later time when the female partner undergoes an IVF procedure and the previously frozen sperm are used in an IVF cycle. When such techniques are utilized, extremely low sperm counts can still be highly successful.
Some circumstances exist where the sperm counts are too low to even consider IVF, or despite aggressive treatments a pregnancy does not occur. Under such circumstances, some couples will want to explore the use of donor sperm. We have worked with a number of excellent sperm banks through the years, which has helped us to achieve happy results for many couples.