Male infertility is a medical issue in which the male is unable to impregnate his female partner. This affects around 15% of couples. The sperm is inefficient in fertilizing the egg of a female. Infertility is diagnosed when the couple is impotent to reproduce even though they have had routine unprotected sexual intercourse for a year.
30% of all infertility issues originate in male partners.
The treatment for male infertility is typically recommended after identifying the underlying cause of the issue. If the issue cannot be identified, your doctor may recommend evidence based treatments to improve your fertility.
Treatments for male infertility include surgery, repair or correction of damage or abnormalities to reproductive organs, performing medical procedures to directly deposit sperm in the female partner, fertilizing egg in the laboratory , using third party egg or sperm donors, or even a surrogate mother.
Medications can also treat certain issues affecting male infertility, such as erectile dysfunction and hormonal imbalances. Surgery is also effective for repairing varicocele or repairing blocked tubes that transport the sperm.
If treatments fail to restore the fertility, assistive reproductive technologies like vitro fertilization can also be considered.
Table of Contents
Symptoms of Male Infertility
The main symptom of male infertility is the inability to impregnate your female partner. Other symptoms include changes in sexual function or hair growth.
Causes of Male Infertility
There can be numerous issues leading to infertility in men. This can be underlined as under
Ejaculation Issues: During orgasm, the semen may enter the bladder as against coming out the tip of the phallus. This condition is also called retrograde ejaculation. Various conditions can lead to retrograde ejaculation such as:
- Prostrate or Urethra
- Diabetes
- Surgery of the bladder
- Medications
- Spinal Injuries
Some men inflicted with spinal trauma or certain diseases are unable to produce semen despite producing sperm. In such cases, it is possible to retrieve semen for uses in reproductive assisted techniques.
Varicocele: This is one of the most usual causes of infertility in men. It is also reversible. It is characterized by the enlargement of the veins that drains male testicles. The exact reason as to how varicocele hinders fertility is currently unknown. It may be linked to unusual testicular temperature regulation.
Treating varicocele can increase functionality and sperm count, and potentially lead to fertilization using assisted techniques like vitro fertilization.
Chromosome defects: Conditions like Kinefelters syndrome which causes a male to be born with two x and a single y chromosome can lead to the development of irregular male reproductive organs. Other such disorders that hinder fertility in men are
- Kallmann’s Syndrome
- Kartageners Syndrome
- Cystic Fibrosis
Environmental Exposure: Overexposure to chemicals like pesticides or radiation may cause infertility. Smoking, marijuana, alcohol, and consuming certain medication such as anabolic steroids, certain antibiotics, antihypertensives, or others may cause impotence.
Routine exposure to heat, whether through hot tubs or saunas can increase the core temperate of the body and lead to infertility.
Cancer Treatment: Treatment relating to cancer like radiation and chemotherapy may impair sperm production. In certain cases, the effects can be severe.
Tumors: Cancerous and non-malignant as well can damage male reproductive organs. Tumors can cause damage to glands such as the pituitary gland which is related to hormone production.
Problems with sexual intercourse: Certain problems related to intercourse may lead to fertility problems in men. This can be:
- Premature ejaculation
- Painful intercourse
- Erectile dysfunction
- Anatomical abnormalities
- Psychological or relationship difficulties that may interfere with intercourse.
Infection: Some infection may affect sperm count or production or induce scarring that hinders the transit of sperm. This problem can be
- Inflammation of epididymis
- Inflammation of testicles
- Sexually transmitted diseases such as HIV or even gonorrhea
Past operations: Certain surgeries may prevent the ejaculation of sperm. This can include
- Scrotal or testicular surgery
- Vasectomy
- Inguinal Hernia repairs
- Prostrate surgeries
- Significant abdominal operations relating to rectal and testicular cancers.
In Some cases, surgery can restore these blockages or directly retrieve sperm.
Risks Factors of Male Infertility
There are various conditions that put men in danger of infertility such as:
- Overweight: An inactive lifestyle and excess weight can increase infertility risks. Sperm count can also be affected if the man is overweight.
- Underweight: Being below the recommended weight and lack of consuming a balanced and healthy diet may impede sperm count.
- Age: Men over 40 have fewer chances of impregnating their female partners in comparison to younger men. Older men may possess increased rates of certain psychiatric issues or cancers that can cause failure in conceiving a child.
- Tobacco use: Smoking marijuana or marijuana can increase infertility rates in both partners. Smoking can obstruct the benefits of medical fertility procedures as well. It can also result in low sperm count and erectile dysfunction.
- Alcohol: Alcohol must be avoided when trying to impregnate your partner as it can result in decreased sperm count and motility.
- Depression: Severe depression has been proven to cause infertility in men. Sexual dysfunction can also be a consequence of depression
Prevention of Male Infertility
Healthy lifestyle choices can improve your overall health and promote fertility in both you and your partner
Many conditions of infertility in men are not preventable. However certain measures may be undertaken:
- Avoid smoking and excessive consumption of alcohol. This can deplete sperm production and motility of the sperm.
- Avoid excessive temperature. Excess heat can lead to distortion in sperm production. This is usually temporary. However, saunas or hot tubs must be kept at bay.
- Avoid exposure to certain chemicals or environmental toxins which can damage sperm production.
- Exercise routinely. Moderate exercise should be carried out on a periodic basis to increase sperm quality and increase the chances of conceiving.
- Limit medications that affect fertility rates, these can be prescription or non prescription. Consult the doctors of your active medications but do not discontinue prescribed medications without the recommendation of your doctor.
- Avoid a vasectomy
- Reduce stress
- Completely avoid illicit drugs.
Diagnosis of Male Infertility
The first step in treating male infertility is undergoing a thorough evaluation by a doctor specialized in male infertility. The approach will differ with each expert but there is a general outline of the tests that you can expect:
- Analysis of sperm and semen: You will be provided a private room with magazines where you will be expected to produce a fresh semen sample. Your semen will then be assessed for the movement, shape, sperm count, and other variables.
Typically, the higher the quantity of normal shaped sperms, the higher the chances of fertility. But more often than not, there are exceptions. Even with abnormal semen and low sperm counts, many men turn out to be fertile. Additionally, 15 percent of infertile men seem to have a high quantity of normal sperm and normal semen.
It may also come as a surprise that even with no sperm content in the semen (azoospermia), it is considered as a good sign because it may suggest a blocked tube which can be corrected through surgery.
- Physical examination: Varicocele can be detected through a physical examination and will reveal problems in the hormones if any. Ideally, this should be conducted by an urologist.
- Hormone evaluation: Testosterone and several hormones produced in the brain controls the production of sperm. However, in 97 percent of infertile men, hormones do not seem to be the issue.
- Testicular biopsy: This procedure is recommended for patients with zero to little sperm content in their semen. A testicular needle biopsy can detect whether or not a patient is producing healthy sperm. If it shows a good quantity of sperm production, there could be possible blockages somewhere.
- Genetic testing: Expert opinions vary on this. However, the general understanding is that it could identify certain obstacles to fertility and issues with the sperm.
Treatment for Male Infertility
There is no procedure that can enhance the quality of sperm. However, procedures do exist that can improve the prospects of conceiving. The techniques available for infertile men are:
The ultimate goal of treating male infertility is to enable the patient to impregnate a woman. Some causes of infertility can be reversed and conception can be enabled through natural sex.
Below are some commonly performed male infertility treatments:
1. Varicocelectomy
Diagnosis of Varicoceles
If neither you or your physician is able to feel the mass, you will be asked to take a deep breath and hold it while standing. This is called the Valsalva maneuver and this can help feel the enlarged veins.
If this does not work, you will be examined through a scrotal ultrasound. It uses high frequency sound waves to take images of the internal structures of your body. This will rule out any other symptoms for your condition. Sometimes you might be recommended for further imaging to rule out any other causes like tumor.
Treatment of Varicoceles
It is not necessary for you to undergo treatment for varicocele as many men are able to impregnate their partners. Treatment is recommended only if it causes infertility, testicular atrophy or pain. Varicocele repair is also suggested when considering assisted reproductive techniques.
Surgery is performed to seal off the vein that is affected in order to redirect the flow of blood into the healthier veins. For men suffering from infertility, varicocele treatment may cure or improve the infertility or even improve the sperm quality with the help of procedures like In Vitro Fertilization (IVF).
Repairing varicocele in adolescents include pain or abnormal analysis of semen results, progressive atrophy of testicles. Varicocele treatment may improve the characteristics of sperm but it is still not clear if leaving varicocele untreated leads to worsening of the sperm quality.
There are relatively fewer risks to varicocele repair which includes:
- Fluid accumulation around the testicles (hydrocele)
- Varicocele reoccurance
- Infection
- Artery damage
Methods of Repair Include:
- Open Surgery
Usually this procedure is conducted on an outpatient basis using local or general anaesthetic. The vein will be approached via the groin (subinguinal or inguinal) or an incision will be made in below the groin or in the abdomen.
Thanks to advancements in varicocele treatment it has led to a considerable reduction in complications post surgery. One such advancement is the Doppler ultrasound that guides the procedure. Another is the surgical microscope which shows a better visual of the treatment area during the surgery.
Patients can return to non-strenuous normal activities in just two days of surgery. Strenuous activities like exercising can be resumed in two weeks.
Generally, the post surgery pain is mild but it may continue for days and weeks. You may be prescribed pain medication for a certain period of time. Your doctor might also suggest over-the-counter painkillers like ibuprofen (Motrin IB, Advil, etc), or acetaminophen (Tylenol, etc).
You might be advised not to have sex for some time. Typically it takes a few months for the sperm quality to improve after the surgery because it takes roughly three months for the body to develop new sperm.
Open surgery through subinguinal and microscope approach show the highest success rate.
- Laparoscopic surgery: A small incision will be in your abdomen and a small instrument will be passed through the incision to detect and repair the varicocele. The procedure is performed with general anesthesia.
- Percutaneous embolization: This surgery is not commonly performed. Here a tube will be inserted into your neck or vein through which an instrument will be passed through. This will display the enlarged veins on a monitor and the doctor will release a solution or coil that will cause the scarring to block the veins in the testicles. The repair will occur in the varicocele by interrupting the flow of blood.
Typically you will be able to resume normal activities in two days and strenuous activities like exercise in ten days.
Lifestyle and Home Remedies for Varicocele
If your varicocele is not causing any major issues like infertility, you can try out these methods to relief the pain:
- Over-the-counter painkillers: Painkillers like ibuprofen (Mortin IB, Advil, etc) or Acetaminophen (Tylenol, etc) can help relieve the pain.
- Athletic supporter: This will relieve the pressure.
How to Prepare For Your Appointment
First, consult your primary care doctor. In some cases, you will be referred to a urologist first when you call to make an appointment.
Here’s a guide to help you prepare for your appointment and what you can expect from it.
What Can You Do?
- Make a list of the symptoms you have experienced: This will include anything that might not even be related to the reason why you are making an appointment.
- Make a list of important personal information: Include recent life changes and major stresses.
- List the medications you are taking: Supplements, vitamins, or anything you are taking.
- Have somebody with you: Sometimes you may not be able to retain all information given to you during the consultation. Having a loved one with you will help remind you in case you forget.
- List the questions you need to ask so that you don’t miss out on any of the questions.
By listing the important questions you will be able to make the most of your consultation with your doctor. Write down all the questions, both important and not so important.
Here are some questions you can ask when consulting a doctor for varicocele.
- What could be causing the symptoms?
- What tests do you recommend?
- Would you consider my condition temporary or permanent?
- Will it affect my capability to impregnate a woman?
- What are the treatment options? Which one would you recommend?
- How can I effectively manage this with my other health conditions?
- Should I follow any restrictions on my sexual activity?
- Do you offer any printed materials or brochures I can take home? Can you recommend any websites I can visit?
Do not limit yourself to the questions you have prepared. Ask anything that pops up in your head as you discuss with your doctor.
What to Expect
Here are some questions your doctor will most likely ask:
- How long have you been experiencing the symptoms?
- Are your symptoms occasional or continuous?
- Are your symptoms severe?
- Do you notice anything that improve or worsens your symptoms?
What to Do In The Meantime
Wearing an athletic supporter will relieve the pressure and if the pain persists, buy an over-the-counter medicine.
What to Expect Post Treatment for Varicocele
Normal activities can be resumed after one or two days following the surgery. However, you should refrain from strenuous physical activities for at least 2 weeks.
If you underwent an embolization, your recovery will be quicker. However, you will still need to take a day or two of rest at home but you can start exercising within a week to 10 days. It is quite possible for your varicocele to come back after the treatment but it could be a better choice in most cases.
If you had the surgery to treat your infertility issue, your will be tested again in 3 to 4 months as it takes this long for new sperm to grow. Improvements are usually seen within 6 months to 1 year. A little over 50% of men who had this procedure for their infertility have seen positive results.
2. Vasectomy Reversal
Vasectomy reversal surgery is performed to undo a previous vasectomy. The goal is to reconnect each of the sperm carrying tubes (vas deferens) from the testicle into the semen. This surgery enables the sperm to be present in the semen so that you can impregnate your partner.
Depending on the type of procedure, pregnancy rates following vasectomy reversal ranges from 30% to 90%. There are many factors that affect the success rate of a reversal for achieving pregnancy which includes age of partner, time period after vasectomy, experience and training of surgeon, and your history regarding fertility before the vasectomy.
Why It Is Done
There are several reasons why men decide to undergo vasectomy reversal. Some of these include remarriage, change of heart and even loss of child. A small percentage of men undergo vasectomy reversal because of pain in the testicles which is triggered by the vasectomy.
Risks Involved
It is possible to reverse almost all vasectomies but not all reversals guarantee success in conceiving a child. There is no time limit to when you can reverse your vasectomy after you have had it but the longer you wait, the lower the chance of fertility.
Although it is very rare for vasectomy reversal to face complications, here are some possible risks:
- Bleeding in the scrotum: It could lead to accumulation of blood (hematoma) leading to painful swelling. This can be avoided by using scrotal support, applying ice packs to the treated area and taking rest. Find out with your doctor if you need to avoid blood thinning medications like aspirin before and after the surgery.
- Infection: Any surgery carries the risk of infection but it is not common. This may be treated with antibiotics.
- Chronic pain: It is common to experience persistent pain after the surgery.
How to Prepare
Consider these few points before undergoing vasectomy reversal:
- Vasectomy reversal is costly and your insurance may not cover for it. Inquire about the costs in advance.
- Vasectomy reversal has a high success rate when performed by a surgeon trained in microsurgical techniques that includes using surgical microscope.
- The success rate of vasectomy reversal is higher with surgeons who perform the procedure regularly.
- Sometimes this procedure requires vasoepididymostomy which is a complex type of repair. Ensure that your surgeon is qualified to perform this if required.
When deciding on the right doctor make sure to ask how many vasectomy reversals they have done, the success rate in patient fertility and types of techniques they have used. Also enquire about the potential complications and risks involved.
Food & Medication
Consult with your doctor what you need to do before the surgery. You will probably be asked by your doctor to stop taking medications that include pain relievers, blood thinning medications such as ibuprofen (Mortin IB, Advil, etc), aspirin, etc as these can increase your risk of bleeding.
Clothing & Personal Items
Wear tight fitting undergarments like athletic supporter to wear post surgery as it will hold the bandages in place and support the scrotum.
Other Precautions
Take someone with you so you won’t have to drive yourself home. Surgery typically takes 2 – 4 hours or even longer. If the procedure is performed under general anaesthesia, you may need more time to recover.
Before Vasectomy Reversal Procedure
Your Surgeon will likely want to:
- Check your history and conduct a physical exam: This will rule out any health concerns you might have that could possibly complicate the surgery.
- Check if you have healthy sperm: If you have already fathered children before, it is proof enough that your sperm is healthy. If your doctor is not sure, you may have to undergo additional testing.
- Confirm that your partner is also healthy: If your partner is over 40 years or have never conceived before, your doctor might want to run some tests on her like gynaecological exam and more.
Vasectomy reversals are generally performed on an outpatient basis at a hospital or surgery centre. If your surgeon plans to perform it in the clinic, ensure that he or she is trained and experienced enough to perform complex repairs like vaseopididymostomy if necessary.
Vasectomy reversal is more complex than vasectomy as it is usually performed with microsurgery where the surgeon makes use of surgical microscope for magnifying the vas deferens to 40 times the original size. It takes a lot of expertise and specialized skill to perform this type of surgery.
The vas deferens is usually attached in one of two ways:
- Vasovasostomy: Here the surgeon will stitch together the severed ends of each tube carrying the sperm.
- Vasoepididymostomy: The vas deferens is directly attached to the small organ behind each testicle which holds the epididymis (sperm). This procedure is more complicated than vasovasostomy and is opted only if vasovasostomy will not work or cannot be performed.
Choosing between the two surgeries will be determined by whether the sperm is visible when fluid collected from vas deferens is examined during surgery.
In a lot of cases, you won’t even know which procedure will be needed as the surgeon makes the decision during the operation which procedure will be more effective. In certain cases, both surgical techniques are performed – vasoepididymostomy on one side and vasovasostomy on the other.
During Vasectomy Reversal Procedure
The surgery involves making a small incision (cut) on your scrotum so as to expose the tube carrying the sperm. The sperm will then be released from the tissues surrounding it.
The doctor will examine the fluid inside after cutting open the vas deferens. When there is sperm in the fluid, the tips of the vas deferens will be connected to reinstate the passage for sperm.
If no sperm is to be found in the fluid, there is a possibility for the sperm to be blocked by scar tissue. Your doctor might recommend a vasoepididymostomy for this.
Vasectomy reversal is also performed as robot assisted surgeries but only in some select cases.
After Procedure
The incisions will be covered with bandages immediately after surgery. Wear athletic supporter or any tight fitting undergarment and apply ice to the treated area for 24-48 hours to control the swelling.
It is normal to feel sore several days after the surgery. Any stitches will dissolve by itself in one week to 10 days. If your doctor has covered the incisions in bandages, ask when to take them off.
Limit yourself from physical exertion that might cause your testicles to move around a lot. Some pain and swelling is expected as the anaesthetic wears off but it will dissipate in a few days.
Post-Surgery Care
Here are some steps to follow after the surgery:
- For several weeks after the surgery, wear an athletic supporter except when showering. Once you’re off the woods, you can wear it only during workouts.
- Do not wet the surgery site for two days following the surgery.
- For 6 – 8 week post surgery, refrain from activities that may pull on the scrotum or testicles like heavy lifting, biking, sporting activities, or jogging.
- For people with desk jobs, you will be able to go to work after the few days post surgery. However, if your job involves a lot of physical exertion like working, driving or walking, ask your doctor when to go back to work.
- Avoid ejaculation or sexual intercourse until your doctor says it is okay. It could be anywhere between 2 – 3 weeks post surgery.
Results
After some time post surgery, your semen will be examined under a microscope. Unless you impregnate your partner, there may be periodic examination of your semen to see if the vasectomy reversal has worked.
Even when a vasectomy reversal is successful, it may take anywhere between a few weeks to a year or more for the sperm to appear in the semen. Your success in impregnating your partner will depend on different factors like the age of the female partner, quality and number of sperm present, etc.
If the Vasectomy Reversal Fails
Sometimes vasectomy reversal will not work if more blockages develop post surgery or if your surgeon was not able to recognise an underlying issue of the testicle during the surgery. Sometimes a second attempt vasectomy reversal surgery is performed if it doesn’t work in the first attempt.
Sperm freezing through in vitro fertilization is another option but doctors normally don’t recommend this during a vasectomy reversal surgery because it may be unnecessary.
3. Intracytoplasmic Sperm Injection (ICSI)
ICSI or Intracytoplasmic sperm injection is a technique commonly used during In Vitro Fertilization (IVF) process. It is recommended when it is the male factor affecting the infertility.
In this procedure a sperm is singled out and then injected into the female egg directly. In this way the sperm is able to bypass the steps involved in the early fertilization process.
The procedure is done in a fertility lab by a ICSI expert. The selection of the sperm is based on the overall appearance, head shape and its ability to move (motility).
The sperm cell is placed into a thin glass needle which is then inserted gently into an egg for fertilization. What occurs next, including the time taken and the development of embryo corresponds to what happens during an IVF procedure.
How is it performed?
ICSI involves five steps:
- Once the egg is matured, it is held with a special kind of pipette.
- Immobilizing and picking up a single sperm cell is done with the help of a sharp, hollow, and delicate needle.
- The needle is inserted carefully through the egg and into the cytoplasm inside the egg.
- The needle is removed carefully once the sperm is inserted into the cytoplasm.
- The eggs are then assessed the very next day to check for evidence of fertilization.
Once the egg is fertilized successfully, the embryo is physically transferred into the uterus of the woman through embryo transfer procedure. Ultrasound and blood tests may be conducted by a fertility specialist to check if pregnancy has occurred.
Candidates for ICSI
You might be recommended ICSI if:
- Your sperm count is low.
- Your sperm either has poor morphology (abnormal shape) or poor motility (doesn’t move normally).
- Your eggs were not able to or only few were able to fertilize during a previous IVF procedure.
- Your sperm needs to be surgically collected from the epididymis or testicles because of reasons like injury, blockage in the tube, genetic condition, low sperm count, disease, or even a previous vasectomy.
- You are using frozen sperm which is not always the best of quality.
Key Facts:
- ICSI is an effective treatment option for treating male infertility.
- This procedure is a part of the In Vitro Fertilization (IVF).
- The sperm is directly injected into the egg.
- Some men may require the sperm to be extracted surgically.
Male infertility can be caused by various factors like poor sperm movement (poor motility), poor sperm quality, low sperm count, inability of sperm to penetrate into the egg or even azoospermia.
How Sperm Is Retrieved in ICSI?
If you have sperm with poor motility (poor movement) or low sperm count, the sperm can be retrieved through ejaculation. If you have had a vasectomy, vasectomy reversal would be a more cost effective option.
If a vasectomy reversal surgery has failed or if you do not want surgery, microsurgical sperm retrieval or aspiration are effective alternatives.
Needle Aspiration: It is a procedure done under sedation with little discomfort. There is, however, potential swelling and pain afterwards. This procedure allows the doctor to quickly and easily collect the sperm to be used for the ICSI. The sperm is extracted directly from the testes using a tiny needle.
Sperm collected from the testes is appropriate only for procedures like ICSI when the sperm from the testicles are unable to enter the egg without external assistance.
Success Rate of Intracytoplasmic Sperm Injection
Many couples have had positive results in fertilizing the sperm and egg. The success rate in ICSI is quite similar to the success rate of IVF. Approximately 70 – 75% of eggs were able to fertilize through the ICSI procedure.
However, just like with conventional IVF treatment, the success of ICSI depends on many factors like the fertility issue of the female partner, her age, etc.
Outlook
There are studies that indicate that babies conceived through artificial insemination methods like ICSI could possibly have a higher chance of birth defects like imprinting defects.
Imprinting is a phenomenon where some genes function differently based on whether they are related to a certain chromosome passed down from the mother or the father. Discuss at length the potential risks or complications with your reproductive specialist before you do a ICSI.
4. Hormone Therapy
The brain releases hormones called gonadotropins that stimulate the testicles for sperm production. Taking these hormones in the form of medication can increase sperm production.
5. Artificial Insemination
Artificial insemination is a simple procedure that has very few side effects and can be a solution to couples struggling to get pregnant.
In artificial insemination, the sperm is fertilized by setting it inside a uterus. One of the most popular methods is the Intrauterine Insemination (IUI), where the sperm is placed directly in the uterus. The aim is to enlarge the number of sperm reaching the fallopian tubes and thereby increasing the probability of fertilization. It is a less invasive option to IVF. It is also significantly more affordable.
IUI is routinely used to target low sperm count or motility.
How is it helpful?
It helps the sperm get around possible obstructions and makes the trip shorter, making it easier for the sperm to enter the woman’s uterus, fallopian tubes or cervix.
Who Is It For?
IUI can treat many types of fertility issues. It can help infertile men when their sperm is not strong enough to get inside the fallopian tubes through the cervix.
IUI is also suggested when doctors are unable to detect the reason behind a couple’s infertility.
IUI may also be utilized to treat the following:
- Unexplained infertility
- Ejaculation dysfunction
- Hostile cervical state, including mucus issues
- Scar tissue in the cervix from previous procedures which may prevent the sperm from entering the uterus
Procedure for Artificial Insemination
Insemination is usually performed during ovulation of the female partner, which is usually 24 to 36 hours following the LH surge or after administering the hCG “trigger” injection. Ovulation is usually predicted through a blood test or urine test and ultrasound.
For this procedure, you need to avoid having sex for 2- 5 days prior to the surgery in order to ensure there is a high sperm count. If you are uncomfortable and live close to the hospital or clinic, you can collect your semen sample at home in the privacy of your room.
It is important to make sure your semen sample reaches your doctor’s clinic fast because the sperm needs to be “washed” or separated within one hour of ejaculation.
“Washing” the sperm is necessary as it will remove potentially toxic chemicals present in the semen that may possibly trigger adverse reactions in the uterus and increase the chance of getting pregnant.
“Washing” or separation is also a necessary step as it will select motile sperm from the ejaculate and get a more concentrated volume.
The success rate for IUI varies. Here are some reasons that could lower the chances of success:
- Older age of the female partner
- Poor sperm or egg quality
- Severe endometriosis
- Damage to fallopian tubes
- Blocked fallopian tubes
Other Issues with IUI
IUI does not work for everyone. You and your partner may have to try multiple times before successfully conceiving while it may not work at all on some.
Typically your doctor may suggest you to try at least 3 to 6 times with injectible hormones before seeking out other treatments. If IUI doesn’t work for you, you can move on to other approaches like In Vitro Fertilization using your own eggs or with a donor egg.
Costs
The prices for IUI vary depending on the doctor, hospital, location, etc. For instance, some countries like Thailand offer cheaper rates although the services are on par with Western countries.
It is wise to compare the costs before you settle for a clinic. Make proper inquiries and ensure that the estimate that is given to you includes the cost of the sperm washing as well the fee for the hormones and any other drugs that will be used during the procedure.
For couples using sperm donors, there will be an extra charge for each dose that you use. Remember to ask your clinic which costs could be covered by your insurance.
6. In Vitro Fertilization
In vitro fertilization is one of the many treatment options available for male infertility. Here the sperm and eggs are collected and mixed in an incubator. Once the egg is fertilized, it is injected into the uterus of the female partner.
7. Medication
For some men with fertility issues, medication can help in improving the sperm count. Estrogen receptor blockers like clomiphene citrate can stimulate the pituitary gland and hypothalamus in the brain.
It will stimulate hormone production and release luteinizing hormone (LH) and follicle stimulating hormone (FSH) which in turn will increase the production of sperm.
You should get a prescription from your doctor and follow the instructions on how frequently to take it. These are oral medications, meaning it is taken by mouth.
Men suffering from low levels of testosterone may also be given human chrionic gonadotropin which will help adjust the LH and FSH levels and increase the production of sperm. It is injected to the body thrice in a week and may last for up to 6 months.
Your physician will conduct blood tests regularly to check the testosterone levels and adjust the dosage accordingly.
Using synthetic testosterone is not recommended neither prescribed as it decreases the sperm count.
8. Assisted Reproductive Techniques
IUI is an assisted reproductive technique which is also known as artificial insemination. This is a treatment normally recommended when a man has a low sperm motility or low sperm concentration. Your physician may suggest it if there is nothing wrong with the sperm count but the reason for infertility cannot be determined.
In this procedure the male partner’s semen is collected and then “washed” to remove naturally occurring hormone-like compounds like prostaglandins. Prostaglandins may interfere with the conception and cause muscle cramping in the uterus.
The procedure is said to produce a higher concentration of quality sperm. It is then implanted into the uterus of the female partner for conception just before ovulation.
If the semen does not show any sperm production or there is other related issues inhibiting the conception, a donor sperm can be suggested. The donor sperm will be obtained from a sperm bank and then placed inside the woman’s fallopian tube or uterus via artificial insemination.
Male Fertility Treatments You Can Try At Home
Male infertility can be frustrating especially if you have been trying with your partner for a long time. Before you opt for expensive treatment, you can try safe home remedies that can actually maximize your fertility.
For starters, avoid activities like drinking excessive alcohol (more than two drinks per day), tobacco, cocaine, marijuana, etc which can harm sperm production. Also avoid whirlpools and hot baths high temperatures can slow down the sperm production.
Over-the-counter androgens such as DHEA (used in weight training) or testosterone supplements can also trigger infertility issues. Leading a healthy lifestyle can help. Healthy habits like proper nutrition and adequate sleep can improve fertility.
When to seek professional help for male infertility?
If you are a man, you make seek professional intervention for the following;
- Low sperm count or other problems related to your sperm
- You previously underwent treatment for cancer
- If your testicles are smaller than the average size
- Swelling of your scrotum
- You have a family history of infertility
- You previously suffered from prostate, testicular or sexual problems.
Impotency to conceive a child can be stressful and saddening. However, there are various treatments available. You should seek out medical help along with your partner to resolve your problem.
References:
https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317
https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/infertility-in-men
https://www.urologyhealth.org/urologic-conditions/male-infertility
https://americanpregnancy.org/birth-defects/
