Fertility Options for Men
Some of the factors affecting fertility include mumps, high fever, diabetes, a previous injury or surgery, or infections such as sexually transmitted diseases, chemical exposure, stress, drug and alcohol use, medications, exercise habits, timing and frequency of sexual intercourse, and family fertility history.
A semen analysis is a test which evaluates the quality and quantity of sperm and seminal plasma. This may detect factors that impair the sperm's ability to travel to the fallopian tubes or penetrate the egg. Since sperm counts may change daily, more than one sample may be needed.
Sperm motility is the sperm's ability to swim progressively forward. At least 50% motility is considered normal (World Health Organization-1992).
A sperm count below 20 million per mL is considered subfertile (World Health Organization-1994).
Abnormally shaped sperm cannot fertilize an egg. At least 30% of sperm should have normally shaped heads and tails (World Health Organization-1994).
The postcoital test, performed 12 to 18 hours after intercourse, is used to evaluate male infertility, in addition to and in some cases instead of a semen analysis. There should be at least 5 progressively motile sperm per high powered microscopic field (400x) 12 hours after intercourse. Couples with no male or cervical factor may have more than 100 motile sperm. A poor postcoital test may be due to mucus factor (infection, too thick or too little mucus), poor semen quality, or mechanical problems (sperm not reaching Cervix).
Antibody tests determine whether the man or woman produces antibodies to sperm. Antibodies in blood, cervical mucus, or seminal fluid, may react to sperm as invaders and destroy or immobilize them.
Increased white blood cells (WBC) in semen indicate infection. There should be fewer than one million WBC per mL (World Health Organization-1992).
Male Infertility Treatments
Infections of the reproductive tract affecting fertility can usually be treated with antibiotics.
Improving Sperm Concentration
Sperm washing concentrates the more active sperm, which can then be inseminated into the woman.
In vitro fertilization (IVF) is often the only way to avoid sperm antibody problems.
Fertility problems related to varicoceles, ductal obstructions, or ejaculation can usually be treated. If a man chooses to reverse a vasectomy, the procedure itself is usually successful, but fertility may not be restored.
The Fertility Institute of New Orleans is pleased to work with the patient’s own urologist or will recommend a urologist.
Artificial Insemination with Husband’s Sperm (AIH)
Artificial insemination with husband’s sperm (AIH) is most often successful in cases of cervical mucus infertility and problems of intercourse, and may be successful if semen quality is only a little below fertility standards. When semen quality is too low for AIH to be successful, in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may still be successful. When no sperm are present, therapeutic donor insemination (TDI) may be an option. AIH is much more successful when sperm is placed in the uterus [intrauterine insemination (IUI)].
Semen Quality Required for Successful AIH
Successful AIH is dependent on five factors:
- Semen quality which need not be as high as World Health Organization (WHO) standards (see Results of AIH).
- Method of preparing sperm for insemination (swim-down technique, presently used at The Fertility Institute of New Orleans, and swim-up technique appear to result in higher pregnancy rates than wash techniques.
- Timing and method of insemination (IUI best) (either Luteinizing Hormone surge or human chorionic gonadotropin may be used).
- Number of preovulatory follicles (follicle number may be improved by ovulation induction drugs).
- Presence of pelvic disease (pregnancy rates in IUI cycles are only half as high if tubal adhesions or endometriosis is present).
Parameters for AIH
The Fertility Institute of New Orleans’ database contains complete records of sperm quality and treatment from more than 5,000 AIH and TDI cycles. When initial semen quality is less than needed for at least a 4% pregnancy rate per cycle, we believe IUI should not be attempted. Instead, IVF, (ICSI), or donor sperm should be considered.
Pregnancy rates per cycle will be doubled when pergonal or metrodin are used from cycle day 2 or 3. Results are halved by endometriosis or tubal adhesions.
Results for CC remain constant for three or four cycles of IUI and then decline rapidly. Results for pergonal and metrodin decline rapidly after three cycles.
The semen parameters for IUI are concentrations >5x10(6)/ml, total count >10x106, normal morphology >30%, progressive motility >20%, total motile sperm >5x10(6). When these parameters are met or exceeded the pregnancy rates with one follicle ranges from four to ten percent.