Male Infertility Evaluation

Semen Analysis

Male infertility means that a man may not deliver the appropriate quantity or quality of sperm to reach and fertilize an egg. The semen analysis assesses the morphology, sperm count and motility of sperm. Two samples may be required to establish a diagnosis of male infertility. An abnormal semen analysis will usually prompt further investigation. Additional tests may include hormonal evaluation, testicular examination, and in some instances, a chromosome analysis.

Types of hormone problems that can lead to male infertility include, but are not limited to, high prolactin levels, abnormally low testosterone levels or diminished FSH/LH levels (hormones that regulate sperm production by the testes). An examination for physical abnormalities of the testicles, vas deferens and prostate can be conducted by a urologist trained in male infertility. If indicated, our staff will help coordinate care with the appropriate specialists.

In the event of an abnormal semen analysis, intracytoplasmic sperm injection (ICSI) may be recommended to increase chances of successful fertilization. ICSI involves isolating a morphologically normal single sperm in order to inject it into an egg.  Learn about the risks associated with ICSI.

The Evaluation

Sperm production is regulated by pituitary hormones called gonadotropins. These hormones include follicle stimulating hormone (FSH) and luteinizing hormone (LH). FSH is mostly responsible for sperm production, whereas LH is mostly responsible for testosterone production. These hormones can be evaluated for abnormalities which cause inadequate sperm production. Excessive testosterone or other androgens such as DHEA can cause a reduction in sperm production by decreasing circulating levels of FSH and LH. Men should avoid supplements unless recommended by their physician. In addition to supplements, hormonal imbalances may result from effects of other hormones with the body. Prolactinomas (pituitary tumors that secrete prolactin) and thyroid abnormalities can also lead to abnormalities in sperm production and function. Transient events such as illness and infections may also alter the hormonal regulation of sperm. However, these effects are usually temporary and typically improve with time.

Treatment for Male Infertility

When physical barriers to sperm production exist, there are specific procedures that can help. Below is a sample of some of the procedures performed by North Dallas IVF for male infertility:

  • Vasectomy reversal: For men using a vasectomy for birth control, their vas deferens has been interrupted to prevent the passage of sperm. A vasectomy reversal can restore the opening in some cases. Sperm may also be retrieved by testicular aspiration and combined with ICSI. Antisperm antibodies can often be a problem impeding pregnancy even after successful cannulation of the vas deferens. Additionally, it is not uncommon to see declining sperm counts over time after a vasectomy reversal.
  • Varicocele ligation: When excessive dilation of the blood vessels around the testicles occurs, excessive heat may build up. The vessels, or varicocele, can be bound together to allow the testis to return to normal temperatures. Often there is an appreciable increase in sperm parameters with varicocele ligation. ICSI can also frequently overcome the problems with sperm parameters caused by having a varicocele.
  • Testicular biopsy: In this procedure, a portion of testicular tissue is collected. This can serve as a diagnostic tool for abnormal testicular tissue and can also be one of the last remaining sources of sperm for some men. There is a higher likelihood of immature sperm and the sperm retrieved will likely be in low numbers. ICSI is essential following most biopsy and aspiration procedures.
  • Testicular Sperm Extraction (TESE): This procedure involves sperm aspiration or retrieval from the testicle. Essentially, this is a testicular biopsy performed for treatment purposes as opposed to diagnostic purposes.
  • Microsurgical Sperm Aspiration (MESA) or Percutaneous Epididymal Sperm Aspiration (PESA): Both are procedures through which sperm is retrieved from the epididymis.

Your fertility specialist will discuss the most appropriate therapeutic options with you prior to proceeding with any treatment. The procedures can usually be performed right in our office with the assistance of a male infertility trained urologist and anesthesiologist. Sperm aspiration techniques and surgical correction of anatomical problems have given many couples hope. Another option for some patients may be using donor sperm. Our staff is here to guide you and provide resources to help you. You and your partner should make an informed decision about the options that are right for you and visit with our staff about any questions or concerns you have.

Get more information about Semen Collection/Cryopreservation.

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