Approximately
10% of couples will experience difficulty conceiving a child. In about a third
to half of the time, the male will be all or part of the source of the problem
with conception.
The statistics
that are frequently quoted for infertility are again, 10% of couples experience
this problem. About a third of the time it is the male only, one third the
female only, and the last third both have problems. In the female, lack of
ovulation, blocked fallopian tubes and inability for a fertilized egg to attach
to the lining of the uterus are the most common causes. Gynecologist deal
with the female “factor” as we call it. The “male factor”
includes similar causes. Failure of the testicle to produce sperm, or inadequate
production, or a blockage in the system.
As
a general rule, we don’t usually recommend that couples become concerned
about infertility until they have around a year of unprotected intercourse,
with proper timing of sexual relations. Sometimes we will push up the timetable
if patients are older or just because of their concern. The evaluation of the
male is usually pretty simple. A medical history, especially looking for evidence
of previous genital trauma or surgery, exposure to radiation, toxins or drugs
or medication is assessed. Any problem with erection or ejaculation is questioned.
Physical exam can include the testicles, the spermatic cord, and sometimes the
prostate gland. The next step is semen evaluation with a “sperm count”
Technically there is much more involved than just a “count” but this
is often what the test is called. If all is normal here, end of discussion.
If not, a second sample may be requested. Sometimes blood tests looking a specific
hormones are needed.
Treatment
of male infertility depends of course upon the cause. Some men are producing
no sperm, and we have no way yet to help this situation. A condition called
varicocele is common. This is a series of varicose veins that occur in the scrotum.
Why this may cause low sperm counts is unknown, but surgical treatment of this
problem results in improvement in about 70% of men. If sperm tubes are blocked,
there are surgical procedures to attempt to reverse the blockage. (see vasectomy
reversal this web site) In the very difficult case where the man is producing
sperm but they are not arriving in adequate numbers, there are techniques to
retrieve one, or a few sperm directly from the testicles and with inv-vitro
techniques with the female egg, produce an embryo that can be implanted into
the uterus,. As these techniques become more and more complicated the costs
go up, and the success rates go down. However, for the couple determined to
“pull out all the stops” to achieve pregnancy, there is a great deal
we can do.