LCHM Summer 2017 - 10

FEATURE

When male factor infertility is diagnosed, the couple should consider
making an appointment with a Reproductive Endocrinologist and Infertility
Specialist (REI), or a Urologist who
specializes in male factor infertility.
These physicians may provide options
to correct or improve the sperm abnormalities. They may also offer various
treatments to enable pregnancy for
those with multiple sperm abnormalities.
Sometimes, simple lifestyle and/or medication changes can lead to improvements
in the semen analysis. It is important to
keep in mind that it takes sperm three
months to be developed and matured,
so any treatment will take three to six
months to result in improvements.
Occasionally there are hormonal imbalances which may be treated to improve
sperm production. If there is low production of testosterone, without testicular
failure, treatments such as clomiphene
citrate, human chorionic gonadotropin
(HCG) or follicle stimulating hormone
(FSH) injections can increase testosterone
production, thereby improving sperm
count and quality. Taking a testosterone
supplement has the opposite effect, suppressing testosterone in the testes and
lowering the sperm count. Testosterone
or its derivatives should not be given to
men who want to have children.
A urologist may also be able to treat male
infertility surgically if there is a blockage of
the vas deferens or if a large varicocele exists.
A vasectomy reversal is most successful
with a microscopic surgical procedure
performed less than seven years from the
initial surgery. If a reversal is unable to be
performed, an alternative is to obtain sperm
from the vas deferens for In Vitro Fertilization (IVF) with Intracytoplasmic Sperm
Injection (ICSI). Repair of a varicocele is
likely to improve sperm counts, but may
not always lead to fertility. If a pregnancy
hasn't occurred within six months after the
surgery, a repeat semen analysis and a test
for sperm antibodies should be performed.

10 Lehigh County Health & Medicine | SUMMER 2017

FACTORS MOST
COMMONLY IMPACTING
MALE FERTILITY INCLUDE:
Medical issues
Lack of sperm production
Low testosterone
Undescended testes
Testicular failure
Hormonal such as thyroid or pituitary imbalances
High blood pressure
Diabetes mellitus
Cancer treatments including
Chemotherapy especially alkylating agents
Surgery to testes
Radiation
Obstructions that prevent
the release of sperm
Congenital
typically associated with cystic fibrosis

Post vasectomy
Traumatic
Varicocele

Dilated blood vessel in the testes

Prescription drugs that are known to
affect sperm production including:
Anabolic steroids
Cimetidine
Finesteride
Spironolactone
Calcium channel blockers
Sulfasalazine
Sexually transmitted disease
(STD) or other infections (Mumps)

Lifestyle or environmental factors
Prolonged exposure to heat
(ie, hot tubs or whirlpools) or professional exposure
such as welders or cooks
Alcohol consumption
Cigarette smoking
Lubricants
(including petroleum jelly or vaginal creams)

Illegal drug use
Marijuana
Cocaine
Illegal use of anabolic steroids
Opioids
Exposure to environmental toxins

The female partner should also receive testing to determine if she has
factors contributing to the inability to
conceive. These tests can be done by
either a general OB/Gyn or an REI;
however, often the treatment options
require the expertise of an REI. Even
though male factor may be the cause
of the infertility, it is often best treated
by procedures requiring that the female
undergo treatment. One of the simpler
solutions is Intrauterine Insemination
(IUI) where sperm is placed directly
into the uterus, using a small catheter.
Usually, the female is required to ovulate
more than the typical one egg per cycle
so that the sperm has a higher chance
to locate and fertilize an egg. Either
she can take oral (clomiphene citrate or
letrazole) medications or FSH injections
to ovulate multiple eggs (superovulate).
IUI alone without superovulation has not
been shown to improve pregnancy rates
unless a mechanical factor exists. These
procedures are usually successful when
sperm counts are only slightly diminished.
Donor sperm can also be used for IUI if
a couple chooses this option.
For more severe male factor, In
Vitro-Fertilization (IVF) is advised
in which eggs are harvested and the
sperm is injected into individual eggs
by intracytoplasmic injection (ICSI).
With absent sperm or counts less than
1 million, surgical procedures can be
performed on the testes or epididymis
to obtain sperm for ICSI. The female
partner must take hormone injections
to produce multiple eggs for fertilization,
typically about 10-15. However, IVF
techniques have improved to the point
where implantation rates for embryos
are over 50 percent, so it is advised to
replace only one embryo into the uterus,
leading to much lower multiple rates
than previously found with this procedure. It also allows for multiple healthy
pregnancies years apart from a single egg
retrieval as cryopreservation and biopsy
techniques of embryos have improved.



Table of Contents for the Digital Edition of LCHM Summer 2017

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