Info about Fertility
Male Fertility Problems That Could Cause Difficulty Getting Pregnant
When a couple is having trouble getting pregnant, both the man and woman must be examined and evaluated. A reproductive endocrinologist or an andrologist—a specialist in male infertility—tries to determine whether your partner's sperm are healthy, well-formed, mobile, and numerous, and that the seminal fluid is normal. If any of these characteristics are not normal, additional tests may reveal infections, hormonal imbalances, or other problems. Most of the problems are correctable, enabling you both to continue pursuing having a baby.
Male fertility evaluation begins with a semen analysis. Your partner will be given a sterile specimen cup and will be asked to step into a rivate room supplied with a few magazines. He will need to masturbate until he gets semen into the cup. Male sperm must be analyzed to see if they are healthy and if there are enough sperm in the semen. Although it is not ideal, if your partner is uncomfortable with masturbating or is prohibited from doing it for religious reasons, a sample may also be obtained by sending you both home and letting him try to get a sample after intercourse by withdrawing before ejaculation, or by using a laboratory-approved condom. Your partner must follow special instructions to ensure that he gets as uncontaminated a sample as possible. The withdrawal method of collection can result in a smaller sample or one that may be contaminated by vaginal bacteria.
Once collected and sent to the lab, the semen analysis begins. The sperm are examined for number, shape, movement, and presence of infection. Well-shaped, motile sperm are a good indicator of male fertility.
• Low Sperm Count and Ability to Ejaculate
Sometimes the specialist finds only a few sperm in the sample. Few sperm or a low sperm count does not necessarily prevent fertilization.
Sperm count is the number of active sperm in a certain amount of semen and normal is usually 20 to 150 million sperm per milliliter. However, conception can and does occur with far fewer sperm. If the sperm count is low, the andrologist, using X-ray or ultrasound analysis, looks at the reproductive structure—to see if something is preventing the sperm from leaving the testes and being ejaculated.
Structural injury to the vas deferens—which are the ducts, or tubes, that lead from the testes to the penis and are necessary for ejaculation of sperm—is the most common cause of low sperm count. The vas deferens may have been blocked on purpose with male sterilization—a vasectomy, or by previous unrelated surgery. Or they may have been blocked by disease, sexually transmitted or otherwise. In some cases the andrologist may be able to open the blockage during the diagno-S1s. In others, microsurgery may be successful in repairing the blocked vas deferens.
Sometimes the sperm appear quite normal except that they don't move. If that proves to be the circumstance, the specialist may want to extract a sample of sperm directly from the testes to see if sperm from there can move normally. Some men have nonfunctioning sperm in their ejaculate but live sperm in their testes. This is thought to be caused by chemicals in the seminal fluid that are not usually harmful but, for unknown reasons, are harmful in certain cases.
Having abundant sperm is not the most important factor in male infertility. Equally important factors are motility, or the ability of the sperm to move, and the ability of the sperm to penetrate the egg. The sperm must be able to wriggle forward and break through the zona, or covering, of the egg. Sperm that have been ejaculated go through the acrosome, or egg-penetrating, reaction once inside the female reproductive system. The sperm pick up speed, a process called capacitation, and release digestive enzymes from the acrosome cap at the top or "head" of the sperm. The digestive enzymes allow sperm to get through the egg covering and fertilize the egg.
• Treating the Inability to Ejaculate
Some men are not able to ejaculate. Inability to ejaculate can be caused by problems such as diabetes, surgery on the prostate gland or urethra, blood pressure or other medications, spinal cord injury, cancer treatment, or impotence. For some of these cases, reproductive specialists can use electrical stimulation to cause an ejaculation or surgical removal of the sperm.
• Treating Low Sperm Count
As mentioned above, absence of sperm or low sperm count may be due to a variety of factors including abnormalities of the semen, testicular structural blockage that cannot be repaired, hormonal imbalance, inability to ejaculate, or inability of the sperm to penetrate the egg and fertilize it. Fertilization requires a series of chemical reactions that allow one sperm to penetrate one egg cell. If that does not happen, a single sperm can be collected from the semen or from the testes and injected directly into each mature egg to produce embryos. This is one kind of assisted reproductive technology, which we will discuss next.