There is a wide range of treatment options available to help couples successfully conceive despite male infertility. Since the severity of infertility ranges, recommended treatment may be simple, like sperm washing, or may require in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) if more advanced treatment is needed. ICSI is a procedure that injects a single sperm into the egg for fertilization.
Semen analysis is the first step in evaluating male infertility. It allows us to tell how many sperm are present, how many appear normal, and how many are moving. The analysis gives information about the volume, viscosity or thickness, sperm concentration, motility, Kreuger’s morphology, and the forward progression of the sperm. This test also allows us to check for the presence of white cells and bacteria, which can indicate infection.
A sample for analysis can be given at home, following a period of 2-3 days abstinence from ejaculation, and brought to the office in a sterile container within an hour of ejaculation. The semen sample should be kept at body temperature during its transport. Lubrication should not be used in obtaining the sample because it can be toxic to sperm.
Semen Concentration is the number of sperm in the given specimen, measured in millions/milliliter. Normal range is above 20 million/milliliter.
Sperm Motility is measured as the number of motile sperm as a percentage of the total and the quality of the forward progressive movement of the sperm.
Kreuger’s Morphology looks for normal sperm form, meaning an oval shaped head with normal acrosome and properly attached tail.
Female infertility has many different causes. Several hormones can be responsible for infertility problems. These hormonal abnormalities include:
Thryoid – Both underactive and overactive thyroid can cause infertility. A thyroid stimulating hormone should be examined before further testing.
Prolactin – A hormone secreted from the pituitary gland. At an elevated level it can interfere with ovulation; like thyroid, part of the initial assessment for female infertility.
Progesterone – Helps prepare the uterine lining for the implantation and growth of a fertilized egg. Peak secretions of progesterone occur during the luteal phase of a woman’s cycle. If inadequate amounts exist, the embryo may not be able to implant or can result in miscarriage.
Estrogen – Estradiol, secreted from the ovary, needs to correspond with egg maturity and number. If levels are too low during ovulation, pregnancy is unlikely.
Luteinizing hormone (LH) – If this hormone is too low, eggs may not release. Amounts peak pre-ovulation.
Other factors that contribute to infertility are age, weight, and smoking.
Age – Women are most fertile between the ages of 16 and 24. Between 24 and 35 there is a slight decrease in fertility, with a significant decrease happening from ages 35-40. After age 40, fertility profoundly decreases and women trying to conceive should seek aggressive fertility treatment.
Weight – Both over- and under-weight or malnourished women can suffer from infertility issues. However, in some cases bringing weight to a normal range may improve fertility enough to achieve pregnancy.
Smoking – As it generally has negative effects on health, smoking is also associated with infertility. IVF treatment centers have found that pregnancy rate is increased in non-smokers.
There are other medical reasons for infertility aside from these hormonal and life factors. These are some other causes of infertility:
Anovulation – When no egg is produced without some sort of medical stimulation. Not regularly getting a menstrual period can be a sign of anovulation. Medication can sometimes cause an egg to be produced in women who normally do not produce.
Tubal or Uterine Problems – The fallopian tubes allow the egg to pass through to the uterus and sperm need to swim to them in order to fertilize the egg. Checking for a fallopian tube block should be part of an initial assessment. Uterine cavity irregularities may also cause problems. Irregular uterine lining increases the chance of miscarriage.
Polycystic Ovarian Syndrome (PCOS) – May be detected by one of the following symptoms: elevated fasting insulin levels, obesity, hirsutism (excessive hair growth), acne, cystic appearing ovaries found on ultrasound, or a darkening of skin in skin fold areas
Endometriosis – When endometrial cells are found outside of the endometrial cavity it can interfere with the ability to cycle normally. Symptoms include severe menstrual cramps and heavy or prolonged periods. Treatment of severe endometriosis may improve fertility.
Unexplained Infertility – Unfortunately, some infertility issues seem to be unexplained. This is a difficult problem since no reason for infertility can be found and therefore, treated. These issues should be examined carefully since around 40% of infertile couples have a male issue.