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MALE INFERTILITY

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Choose Dreamflower for Comprehensive Diagnosis, Evaluation, & Treatment of Male Infertility

Of the over seven million couples facing infertility, approximately 40 percent have a primary diagnosis of male factor. We understand that, to many men, this finding can seem like a devastating blow. At Dreamflower IVF Centre, we can offer all couples diagnosed with male factor infertility hope and the advanced treatment necessary to achieve a successful pregnancy.

Conceiving a child is your priority, and helping you identify anything that stands in your way is ours. The doctors at Dreamflower will conduct a complete evaluation to identify the causes of your male infertility. We will order a full semen analysis, endocrine profile, and additional testing if indicated.

Depending on the results of these tests, your doctor may refer you to a urologist, who can identify many of the common causes of male infertility including anatomic factors such as an obstruction or varicocele, endocrine factors such as complications from diabetes, and functional factors such as erectile dysfunction.

Although infertility impacts both partners, male factor infertility may feel particularly distressing to you. The team at Dreamflower IVF Centre understands the difficulty of this situation, and we offer resources to help you cope with male infertility. If you need advice about how to support your spouse during infertility treatment, we can provide this information as well.

Understanding Male Reproduction can help us pinpoint the Causes of Infertility

Male factor infertility is defined as an abnormality in either sperm production or function. Although this condition is very common – accounting for approximately 50% of all cases of infertility – a proper evaluation of the male partner is frequently overlooked during the routine infertility evaluation.

The purpose of this section is to educate men about their role in the fertility process, as well as introduce the concept and importance of a thorough male fertility evaluation.

Sperm Development and Passage into the Female Reproductive System

Unlike women, who are born with all of the eggs that they will ever have, men produce sperm from the time they enter puberty until late in life. Sperm begin their development in the testicles. While sperm production is relatively rapid, it typically takes between 90 and 108 days from the time that a sperm is produced in the testicles until it is eventually ejaculated.

Once the sperm leave the testicles, they enter a convoluted series of tubules that lead eventually to the penis. During their journey through these tubules, sperm acquire the ability to swim as well as the structural components necessary for them to be able to negotiate their way to the female egg, bind to it, and eventually cause fertilization.

Semen Contains Sperm & Other Chemicals that help with Fertilization

In nature, when a man ejaculates during intercourse, seminal fluid is deposited at the top of a woman’s vagina. In addition to sperm, this fluid contains many chemicals that come from the other male sexual organs – primarily the seminal vesicles and the prostate gland. These chemicals perform important functions and provide support to the sperm along their journey as they continue to mature.

After ejaculation, the sperm bind to the mucus produced by the female cervix. The sperm use the mucus like a ladder, ascending through it into the uterine cavity. The mucus also has another very important function, as its high pH protects the sperm from the rapid death they would face in the very acidic environment of the vagina.

Once inside the uterus, the flagella (tail) of the sperm propels the sperm to the top of the uterus and then into the fallopian tube where it will hopefully encounter the egg. As the sperm travel down the fallopian tube, they undergo a series of reactions that prepare them for the tasks they will have to perform if successful fertilization is to result. These reactions primarily cause alterations to occur in the membrane cap that covers the sperm head during development.

Ovulation and Fertilization of the Egg

When ovulation occurs, the egg leaves the ovary and it is drawn into the fallopian tube. At this time, the human egg is surrounded by millions of cells called granulosa cells. These cells support the egg as it develops. In order for fertilization to occur, the sperm have to release enzymes found on the head of the sperm to clear a pathway to the egg.

Hundreds, if not thousands of sperm release their enzymes during this process. Eventually, one sperm travels through this pathway and binds to the surface of the egg. This single sperm is then brought into the egg itself where the sperm tail detaches and the sperm head – which contains the chromosomes (DNA) – forms a structure called a “pronucleus”.

The egg forms a similar structure and then the two pronuclei merge and fuse, forming a single nucleus inside the now fertilized egg. Once the pronuclei fuse, each chromosome from the sperm seeks out its corresponding chromosome from the egg, and the chromosomes pair off.

Normal Eggs and Sperm contain 23 chromosomes

For example, each sperm contains 23 chromosomes just like each egg. Twenty two of these chromosomes are identified by their specific number (#1-22), based on the specific genes that that chromosome contains, while the twenty third chromosome is called the “sex chromosome”. The sex chromosome that comes from the egg is always an X, while the sex chromosome that comes from the sperm can be either an X or a Y. If the sperm that fertilizes the egg has a Y sex chromosome, the resulting child will be male; if it is an X, the child will be female.

After each chromosome finds its partner, all of the chromosomes replicate before they are pulled apart and the cell divides. In other words, the one cell embryo becomes a two cell embryo. This process continues as the embryo travels back down the fallopian tube into the uterus. Once inside the uterus, it continues to divide, attaching to the uterine wall once it contains at least 128 cells. This attachment – or implantation – occurs approximately seven days after ovulation.

A woman can typically detect a pregnancy with a blood test approximately seven days after implantation, or fourteen days after ovulation.

Enlist an Expert for a Thorough Evaluation of the Causes of Male Infertility

When a couple contacts our Dreamflower IVF Centre for help with starting a family, they can expect to schedule a consultation and a semen analysis for the male partner. Our investigation always includes both partners because male factors are responsible for nearly half of all cases of infertility. For most men, a change in daily habits, low level hormonal treatment, or minimal laboratory assistance will be enough to boost fertility and enable successful conception to occur.

Anatomical Causes of Male Infertility

An obvious sign that something is amiss may lead you to one of our fertility specialists. A testicular mass or a varicocele (a group of dilated veins draining the testicle) should raise a red flag and initiate a call to our office. Similarly, a history of previous scrotal or pelvic surgery or trauma, a spinal injury, or a chronic condition such as diabetes may also alert you to potential problems with conception.

Varicocele: A condition that can adversely affect testicular temperature and sperm quality. A varicocele is present in up to 40 percent of men with fertility problems.

Obstruction: A blockage in the tubes that carry sperm from the testicles to the penis, causing infertility. Previous infection, surgery, cystic fibrosis, or certain types of birth defects can cause obstruction.

Erectile dysfunction: Sexual dysfunction can stem from medical conditions, neurovascular problems, or psychological factors and can interfere with fertility.

Chromosome abnormalities or birth defects: These problems can interfere with sperm production or delivery of sperm to/through the penis, leading to infertility.

Endocrine Factors that Cause Male Infertility

Hormonal signals from the brain control the production of sperm, sexual urges and distribution of sperm. Simple blood tests will reveal any abnormalities, and your fertility specialist can then recommend an effective course of treatment for hormonal causes of male infertility.

Several endocrine abnormalities can lead to low testosterone – which can adversely affect both a man’s sex drive and his sperm production. Using simple medications, we can usually correct this deficiency, restore libido back to normal, and significantly improve sperm production – often back to normal levels. Please see our sections on common causes of Low T and Low T treatments for more information.

Sperm Disorders Are a Leading Cause of Male Infertility

A man’s ability to produce viable sperm can be affected by many factors as time passes. Undescended testicles or inherited genetic conditions can affect reproductive potential, as can certain types of infections – specifically STDs.

Lifestyle Factors that Contribute to Male Infertility

Your initial fertility workup will include a questionnaire to comprehensively address potential causes of male infertility. Your Dreamflower male fertility specialist will want to know:

1. Do you smoke cigarettes or use illegal drugs?
2. Are you exposed to toxic chemicals or heavy metals at work?
3. How often do you use a sauna or hot tub?
4. How often do you work out; do you cycle excessively; do you use any performance enhancing drugs?
5. Is your daily stress level manageable?

Diagnostic Evaluation of Male Infertility

The cornerstone test in the evaluation of male factor infertility is a semen analysis. As part of this simple test, our andrologists assess sperm number (concentration), the percentage of sperm that are actively swimming (motility) and the percent of sperm that have a normal appearance (morphology).

Our state of the art andrology laboratory also has the ability to perform special tests of sperm function, as well as test for the presence of anti-sperm antibodies. In rare cases, such as after a testicular injury, a man’s immune system can produce proteins (sperm antibodies) that can attack his own sperm and inhibit their ability to swim or bind to an egg – causing immunologic infertility.

Male Infertility Evaluation is included in all initial visits to our Dreamflower IVF Centre

While the majority of attention related to the diagnosis and treatment of infertility is directed toward the female, approximately 50% of all cases of infertility are actually due to abnormalities in sperm production or function. Unlike women, who are born with all of the eggs that they will ever have, men produce sperm from the time of puberty until late in life. It typically takes between 90 and 108 days from the time that a sperm is produced in the testicles until it is eventually ejaculated. Therefore, in addition to medical conditions that can adversely affect sperm production in general, any event that occurs during this period of sperm maturation can have an immediate impact on a man’s fertility.

Medical History

The first step in the evaluation of the male involves a thorough medical history – i.e. an office consultation during which your physician will ask you extensively about your basic medical condition, as well as about specific factors that could affect your fertility. It is important to know whether you have fathered any pregnancies, whether they resulted in an ultimate delivery of a live child or not.

In addition, we will discuss any medical illnesses that you may have, either illnesses that you had in childhood such as mumps, or chronic illnesses that you may have such as hypertension. We will also explore any operations that you have had, focusing specifically on any surgical procedures involving the scrotum such as a varicocele repair, treatment of a spermatocele or hydrocele, or even a hernia repair. It is also important to note if you have undergone a previous vasectomy, with or without a vasectomy reversal.

Lifestyle and Fertility Risk Factors

We will next discuss in detail any medications that you are currently taking, as certain medications can affect both sexual performance and sperm development and function. In addition, we will discuss lifestyle factors such as cigarette smoking, alcohol use, and the use of prescription and non-prescription medications. It should be noted that cigarette smoking has been proven to have a significant adverse effect on sperm. Similarly, alcohol consumption, in excess, can adversely affect testosterone production and ultimate sperm function. Finally, certain illicit drugs such as marijuana can also have an adverse effect on sexual performance and sperm production.

Your family history is also important, as certain genetic conditions have been associated with a significant decrease in fertility potential.

Semen Analysis Results Point to Problems with Male Fertility

The semen sample must be examined in order to determine if there are factors present which could reduce the chances for a sperm to fertilize an egg. This examination is known as a semen analysis. It is common for a semen sample to vary from one collection to the next. In order to lessen this variability and to optimize the quality of the sperm in the collection, the male partner will be asked to abstain from having an ejaculation for a brief time before his collection that is to be analyzed.

Understanding Semen Analysis Results

The examination of the sperm will include a count of the total number of sperm present. It will also include a count of the sperm that are moving, or motile. This number of moving sperm is expressed as a percentage of the total. A forward progression indicates if the population of sperm present is, in general, moving in a straight line. Another important evaluation of the sperm is the morphology, or shape of the sperm. The shape can indicate if the sperm is functional or not. The sperm that have a normal shape are more likely to be able to swim to an egg in the woman’s reproductive tract and to penetrate the egg once they have arrived. The deficiencies that are revealed in a semen sample may prevent the fertilization of an egg from occurring but, more likely, these deficiencies may simply reduce the probability of pregnancy.

Abnormalities in sperm production or function cause about 40 percent of all infertility cases. If you have tried for one year or longer to get pregnant with no success, a Dreamflower IVF Centre doctor will order and evaluate a sperm analysis to develop an appropriate course of action.

Sperm concentration – often referred to as a sperm count, it is the number of sperm present in each milliliter of fluid (a teaspoon holds 5 milliliters). A normal concentration is 20 million per milliliter.

Sperm motility – this is the percentage of sperm with movement. At least 50% of the sperm should be motile. This is further broken down into those with progression (moving forward) versus those that are not; at least 50% of all sperm should have forward progression.

Semen volume – total amount of fluid collected in the sperm sample. A normal volume is at least 1.5 milliliters but not more than 5 milliliters.

Total motile sperm count – this is the total number of moving sperm in the sample. To get this number, you multiply the volume by the concentration, and again by the percent that are motile. Usually there are at least 15 million motile sperm in the sample.

Sperm morphology – this refers to the shape of the sperm. Surprisingly, abnormally shaped sperm are common. Many labs use the World Health Organization criteria for grading the shape of the sperm, which considers a sample normal if at least 30% of the sperm have a normal shape. Midwest Reproductive Center uses a much stricter grading system in which the different parts of the sperm are measured. By this grading system, a sample is normal if more than 4% of the sperm have normal measurements.

Viscosity – or thickness of the sperm fluid. Low or moderate viscosity is considered normal.

Leukocytes – these are white blood cells, which are signs of inflammation or infection. A small number of leukocytes can be normal, while more than one million leukocytes per milliliter is considered abnormal

What is DNA fragmentation index?

  • Typically the chances of infertility being attributed to male partner are between 35% and 45%
  • The development of a healthy embryo is initiated when the chromosome in egg unite with chromosome in sperm. These chromosomes contain strands of DNA (deoxyribonucleic acid).
  • The function of sperm is to deliver male DNA to egg
  • The quality of DNA delivered can determine the development of embryo and subsequent milestones during pregnancy

Why is it important to check DNA fragmentation index?

  • Traditionally methods of evaluation of male infertility were limited to a semen analysis that measured the count, motility and morphology of sperm. It did not assess the DNA that was being delivered. The truth is, sperm that appears normal in terms of motility and morphology by traditional semen analysis may exhibit significant DNA fragmentation. Upto 8% of infertile men have high levels of sperm DNA fragmentation despite demonstrating normal semen in tests. Thus, it is very important to gauge DNA fragmentation in sperm to assess male infertility
  • Recent studies suggest that sperm with DNA fragmentation beyond a certain threshold are evidence of compromised male fertility the degree of DNA fragmentation in sperm is measured using a metric called DNA Fragmentation Index
  • Sperm DNA Fragmentation index is usually tested using a procedure called Sperm chromatin dispersion test(SCD). In this routine around 500 sperm cells are analyzed and graded as per size of their halos normal sperm without DNA fragmentation have halos that range in size from medium to large sperm that display a small or no halo point to fragmented DNA.A normal sample is thought to hold less than 15% of sperm with DNA damage.
  • All men diagnosed with abnormal semen are ideal candidates for this test as are those with normal semen and unexplained infertility, previous failed Intrauterine insemination cycles or failed in vitro fertilization procedures

Causes of sperm DNA damage

  • Advanced paternal age
  • Diet
  • Cigarette smoking
  • Alcohol consumption
  • Drug abuse
  • Elevated scrotal temperature (use of hot baths, saunas, laptop computers, prolonged periods of driving)
  • Infection
  • Exposure to environmental and occupational pollutants
  • Varicocele
  • Infrequent ejaculation
  • Drugs, chemotherapy, radiotherapy

Instructions for producing the semen sample for DNA fragmentation testing

  • Abstain from ejaculation for 2 days but not more than 5 days before producing the semen sample for DNA damage testing
  • Collect sample collection container from the clinic
  • Ensure that the container is labeled with your full name, spouse name and identification code number
  • Wash your hands thoroughly with plain water before producing the semen
  • The sample must be produced by masturbation only and ejaculated directly into container .the total sample must be collected
  • The container must be closed tightly following sample collection
  • The sample must be protected from extreme temperatures
  • Deliver sample to the laboratory within one hour of collection

Treatment of sperm DNA damage

  • Depending on what caused the damage to sperm DNA, there may or may not be a way to enhance sperm DNA. Some ways that may help to enhance sperm DNA include lifestyle changes, abandonment of smoking, reduced exposure to toxins and consumptions of daily Zn and anti-oxidant supplements. Other specialized clinical options may be suggested by your fertility specialist