Male fertility factors contribute to infertility in up to 40% of couples. An additional 20% of cases involve both male and female factors, meaning male-related infertility issues are just as common as female ones. Furthermore, research studies suggest that male infertility may be on the rise. Research has also shown that genetic abnormalities in sperm may increase with paternal age, particularly after age 50, potentially impacting embryo development and offspring health.
The first and most important step in male infertility care is to establish an accurate diagnosis. We usually work with each male patient’s urologist to reach this goal. In some cases, male infertility problems can also signal a more serious underlying medical condition, one that may affect overall health or even be passed on to children. Sometimes, the issue is as straightforward as a hormone imbalance requiring hormone therapy. Structural or anatomical concerns, on the other hand, may require the expertise of a urologist.
Semen Analysis
A semen analysis provides valuable insight into sperm quality by measuring:
- Sperm count and concentration
- Sperm motility (movement)
- Sperm morphology (shape)
Please note that, while this test is a useful diagnostic tool, the sperm’s fertilization ability can only be confirmed when conception is achieved.
Male-Factor Infertility: Effects on Offspring
Some causes of male-factor infertility do not increase the risk of complications for offspring, including:
- Acquired obstructive azoospermia from a vasectomy or failed vasectomy reversal
- Infection
- Retrograde ejaculation
- The inability to ejaculate due to psychological or neurological causes, such as spinal cord injury
However, conditions like absence of the vas deferens or testicular insufficiency, which often result in low to zero sperm counts and motility, may stem from genetic causes. Additional testing may be recommended to identify underlying genetic conditions and better understand any risks to potential offspring. It is also worth noting that male infertility is associated with more known genetic abnormalities than female infertility.
Male Infertility Treatment
Results from the above tests and evaluations help us personalize treatment for each individual based on severity and cause of infertility. In mild to moderate cases, less invasive options, such as intrauterine insemination (IUI) or in vitro fertilization (IVF), may be effective, provided sperm motility and count are sufficient. Generally, IUI requires at least 5 million motile sperm, while IVF requires a minimum of 500,000. If the counts are lower, options like sperm banking or using donor sperm may be considered.
Intracytoplasmic Sperm Injection (ICSI)
For patients with extremely low sperm count or motility, intracytoplasmic sperm injection (ICSI) offers a promising alternative. ICSI involves using a microscopic tool to inject a single sperm directly into an egg. This technique has made it possible for many men with severe infertility to father genetically related children – an option that didn’t exist in the past.
Because only one motile sperm is needed per egg, ICSI is used in these cases to optimize the chances of fertilization. Without ICSI, the chance of achieving pregnancy with surgically retrieved sperm is less than 1%. When paired with ICSI, success rates are similar to conventional IVF.
When is ICSI used?
ICSI is typically recommended when:
- Sperm count is less than 5 million
- Motility is less than 25%
- Morphology is below 15% (WHO) or 4% (Kruger)
- Antisperm antibodies are present
- Previous IVF cycles resulted in poor or no fertilization
- Sperm was retrieved via aspiration in azoospermic patients
Sperm Collection
Sperm may be collected through ejaculation or, in more complex cases, with surgical procedures such as MESA (microscopic epididymal sperm aspiration) or TESE (testicular sperm extraction):
MESA is typically used when there is an obstruction (e.g., vasectomy, congenital absence of the vas deferens). The urologist retrieves sperm from the epididymis, which is then frozen for later use. Freezing does not reduce success rates.
TESE is performed when there is no sperm in the epididymis or when azoospermia results from testicular failure. A small tissue sample is removed from the testicle and searched for viable sperm. Because freezing can affect sperm quality, TESE is often performed on the day of egg retrieval.
