Male Infertility, IUI and ICSI to Treat Male Infertility

There have been major advances in the treatment of infertility, particularly male infertility, over the last fifteen years. At one time, infertility was considered a "female problem" with little emphasis placed on the male other than verifying ejaculation.

We now know that male infertility is manifested in many, and sometimes unexplained, ways. The semen analysis is one of the most important tests conducted during the infertility evaluation and it can identify many sperm disorders. Our NY fertility clinics use the Kruger Strict Criteria to evaluate sperm.

These criteria include the quantity of sperm, the viscosity of the ejaculate, the shape of the sperm (morphology), an evaluation of how the sperm swim, and many other characteristics. Given the importance of the semen analysis, it should be performed by a reproductive laboratory.

In the male fertility evaluation, a precise history is taken, together with blood samples, to rule out sexually transmitted diseases (STDs). A fresh semen analysis is obtained in one of our NY fertility clinic locations laboratories after two days of abstinence and the entire ejaculate is collected and assessed without delay.

According to the findings of the initial semen evaluation, the husband may be scheduled for additional tests. Unlike many commercial laboratories, we have a dedicated andrologist who performs the semen analysis according to World Health Organization criteria. Sometimes the analysis is repeated in three weeks, and we screen for sperm conditions caused by excessive alcohol, diabetes, marijuana and other drugs, medical diseases, etc.

There are many causes of male sub fertility and major ones include untreated infection with organisms such as syphilis or gonorrhea, childhood diseases such as mumps, a varicocele, genetics, congenital abnormalities, environmental influences causing abnormally elevated testicular temperature (i.e. prolonged sitting in a hot tub), hormonal imbalances, and many more.

Many times abnormalities can be corrected by modifying the behavior causing the condition. A good example of this is prolonged, repetitive sitting in hot tubs, or wearing restrictive underwear. The testicles must be kept at the optimal temperature for sperm production. The scrotum regulates the temperature by expanding and moving the testicles further from the body (lowering temperature) or contracting bringing them closer to the body (raising the temperature). The scrotum cannot perform its cooling function if tight clothing constricts it. Obviously, testicular cooling is very difficult in a hot tub.

A varicocele is a common cause of sub fertility and occurs where there is a blockage of the veins leading to the testicles. These veins carry "warmed blood" away from the testicles causing cooling. When they become blocked they cannot perform their "heating and cooling" function in conjunction with the scrotum. A varicocele can usually be treated with surgery performed by a urologist.

Fertility drugs are rarely effective in improving sperm quantity or quality. One unique aspect of sperm development is that it requires three months. Therefore, changes made today (environmental or medicine) will not be evident until this time has elapsed. Unfortunately, many fertility drugs have to be given for extended periods making cost prohibitive.

Most men, even those with little or no sperm in their ejaculate, can product genetically related offspring using IVF with intracytoplasmic sperm injection (ICSI). Using ICSI, a single sperm can be withdrawn and inserted directly into the egg.