EVALUATION OF MALE FACTOR INFERTILITY

It may be surprising to some to know that 30% of infertility cases are related to male factor issues. There are many factors which can lead to sperm problems and male infertility, including  childhood diseases (like the mumps), previous surgery or injury, diseases like diabetes, drug or alcohol abuse, sexually transmitted infections, environmental factors, congenital or genetic problems, and hormonal factors. Though not as abrupt or noticeable as menopause in women, changes in fertility and sexual functioning do occur in men as they grow older.

Male factor infertility may be explained by an abnormal SA –Semen Analysis or by other sperm function defects, in the setting of a normal SA as well as functional male defects. Some of these conditions are identifiable and reversible, such as ductal obstruction and HH. Other conditions are identifiable and treatable but not reversible, such as bilateral testicular atrophy secondary to viral orchitis.

The overall goal of the male evaluation is to identify conditions that may affect management or health of the patient or their offspring. Identification and treatment of reversible conditions may improve the male’s fertility and allow for conception through intercourse or through techniques, such as IUI or IVF, when those approaches would otherwise not be possible. Even azoospermic patients may have some degree of active sperm production within the testes or could have sperm production induced with treatment.

The specific goals of the evaluation of the infertile male are to identify the following:

• Potentially correctable conditions;
• Irreversible conditions that are amenable to ART using the sperm of the male partner;
• Irreversible conditions that are not amenable to the above, and for which donor insemination or adoption are possible options;
• life- or health-threatening conditions that may underlie the infertility or associated medical comorbidities that require medical attention;
• Genetic abnormalities or lifestyle and age factors that may affect the health of the male patient or of offspring particularly if ART are to be employed.

Male infertility is typically diagnosed by one or more factors that may include abnormal semen quality or sperm functional parameters; anatomical, endocrine, genetic, functional, or immunological abnormalities of the male reproductive system (including chronic illness); or sexual conditions incompatible with the ability to deposit semen in the vagina. A reproductive history assessment provides important information about lifestyle and sexual history that can contribute to reduced fertility or sterility. The Semen Analysis is an important component in the initial clinical evaluation of the male and his reproductive health. A Semen Analysis provides critical data on testicular sperm production as reflected by total sperm number, the patency and function of the male genital tract and secretions from its associated organs, emission and ejaculation. The SA should include measures of semen volume, pH if indicated, sperm concentration/sperm count, sperm motility, and sperm morphology. Abnormalities in any one or more of these parameters can compromise a man’s ability to naturally impregnate his female partner.