Fertility Programs and Services

Male Infertility Treatment Options

It is estimated that up to 15 percent of couples encounter a problem with fertility. In about half of infertile couples, a male fertility problem plays a role in the couple’s inability to conceive. It is reasonable to evaluate the male partner of all infertile couples before attempting more aggressive infertility treatments, such as in vitro fertilization. Identification of and treatment of factors causing male infertility can often result in pregnancy without other methods.

Male infertility and male fertility issues are not uncommon and they are treatable. Our fertility specialists can help couples to achieve their goal. We are here to guide and support you and through all aspects of diagnosing and treating of infertility.

Causes of Male Infertility

There are many possible causes of male fertility issues. In some cases, more than one factor may be involved.

The most common cause of male infertility is a varicocele — a dilation or swelling of the veins that drain the testicle. It is believed that varicoceles cause male infertility by raising the temperature of the testicles, which may reduce sperm production. An estimated 30 percent to 40 percent of men evaluated for infertility have a varicocele. However, a varicocele does not always lead to fertility problems.
Abnormalities in hormone production, such as decreased testosterone levels, can lead to low sperm counts and lowering male fertility. Other hormones such as Follicle Stimulating Hormone (FSH) and Leutinizing Hormone (LH) may play a role as well.
A wide range of chemical substances can affect sperm quality and/or quantity, including prescription and over-the-counter medications. The following medications have been associated with male infertility:

Anabolic steroids Allopurinol Antihypertensives

Erythromycin Chemotherapy Tetracycline

Cimetidine Gentamycin Nitrofurantoin

Colchicine Dilantin Cyclosporine

Other substances associated with male fertility issues include excessive alcohol, tobacco, marijuana, heroin and methadone. Alcohol, tobacco and marijuana are all toxic to sperm. The duration and amount of exposure is often related to the severity of poor sperm production.
Ejaculatory dysfunction involves a man’s inability to ejaculate during sexual activity. Another type of ejaculatory dysfunction involves the entry of semen into the bladder instead of going out through the urethra during ejaculation (called retrograde ejaculation). This disorder may or may not be associated with a loss of orgasm. Causes include spinal cord injury, surgical procedures, medications that affect ejaculation and psychiatric factors. (This is not the same as erectile dysfunction, which is the consistent inability to sustain an erection sufficient for sexual intercourse.)
Previous surgeries may play a role in male infertility. Surgery in the groin, pelvis, or abdominal area may have damaged nerves or structures necessary for ejaculation.
Testicular trauma or torsion may affect fertility. Testicular torsion is a condition in which the testicle twists on the cord that attaches it to the body. About 30 percent to 40 percent of men with a history of testicular torsion have an abnormal semen analysis.
Diseases such as diabetes mellitus or multiple sclerosis can impair potency as well as ejaculation.
Infections of the reproductive tract, although rare, also can affect male fertility. Bacteria can affect semen quality and can produce an obstruction within the tract, especially at the epididymis. The most common sites of infection are the prostate gland, the epididymis, the seminal vesicles and the testicle. The mumps virus, if contracted after puberty, can affect fertility. Damage to the testicles occurs in approximately 10 percent of men who develop mumps after puberty.
Genetic factors may be responsible for male infertility. Defects (mutations) in specific genes may result in both male and female infertility. Other family members with fertility problems or genetic disorders, such as cystic fibrosis, may suggest a genetic cause.
Vasectomy, a surgical procedure designed to make a man sterile, involves cutting or blocking both the right and left vas deferens, the tubes through which sperm pass into the ejaculate.

Diagnosis of Male Fertility Issues

To evaluate fertility, the first visit will include a thorough health history, blood test, semen analysis and physical exam. If a hormone imbalance is suspected, hormone levels will be tested. Genetic testing using blood tests may also be done.

During the initial physician visit, the physician and the man (or couple if possible) will spend considerable time discussing the possible causes of the infertility, and determining a treatment plan.

Health History

A health history will be obtained during the first visit. We will ask about past infections of the urinary tract, past medical history and surgical procedures, alcohol and tobacco use, medication use, and past testicular trauma. We will also ask about your work environment, such as exposures to chemicals and high temperatures. The health history also includes questions regarding sexual practices and habits, and timing of intercourse.

Physical Exam for Male Infertility

We will perform a physical exam to evaluate factors that may contribute to infertility. About 1 percent of men with a fertility problem have an underlying medical condition, such as testicular cancer, endocrine dysfunction or a genetic disorder. The exam will evaluate the body and the male reproductive organs.

Semen Analysis

The man will be asked to abstain from ejaculation for approximately 72 hours prior to the doctor visit. On the day of the visit, he will be asked to provide a semen sample. The semen sample provides valuable information, including the volume of the ejaculate, the sperm density (count), percent motility (the percent of moving sperm), and speed or progressive motility.

Minimal Standards of Semen Quality

Volume		1.5 – 5.0 milliliters
Sperm		20 million per milliliter
Motility		Over 50 percent
Speed		Grade 3 or higher
Progressive motility		Over 25%

The above values are the “minimum” (vs. “normal”) values. A “normal” sperm count is typically 60 to 80 million, but could be much higher.

For sperm motility (the sperm’s ability to move), at least 50 percent of the sperm cells should be motile. They are also “graded” on the quality of their movement, on a scale from zero to four.

The semen analysis also reports the sperm’s shape, or morphology. To be considered normal, a sperm must have an oval head, a normal mid-piece, and a tail. An abnormal sperm could have a tapered head, or two tails.

The volume of the ejaculate is also measured and reported. A normal amount is at least 1.5 milliliters. Too little semen decreases the odds of the sperm reaching the ovum.

These factors vary on a daily basis, so multiple samples (at least two and often three) are required to establish an accurate baseline. It’s important to remember that the sperm production cycle is about 70 days, with another 15 to 20 days of transit through the ductal system. Therefore, it takes about 90 days for any therapy to be reflected in the semen analysis.

Treatment Options, All Available in Milwaukee, Wisconsin

Many of the causes of male infertility are treatable. The goals of treatment are to treat reversible causes, stop damaging factors, and assist in advanced reproductive techniques.

The treatment plan begins with counseling the man regarding any sexual practices that may impair the chance for conception. These include the optimal timing for intercourse (every 48 hours during the time when ovulation is most likely), and avoiding the use of lubricants — or use them sparingly — that can impair sperm survival.
Lifestyle changes may be a part of the treatment plan. Decreasing the use of certain chemical substances that harm sperm, or eliminating them altogether, may be recommended.
If hormonal abnormalities are found to be the cause of the infertility, hormonal replacement therapy is prescribed. This may be in the form of an injection self-administered throughout the week or a tablet taken every day. Treatment of hormonal abnormalities can enhance libido and energy, and usually results in moderate pregnancy rates, even when sperm counts do not improve dramatically.
Ejaculatory dysfunction can be treated with medication and procedures such as vibratory stimulation, and electro-ejaculation and vasal aspiration, which can produce ejaculation even in men with severe spinal cord injuries. The sperm can then be used with assisted reproductive technologies, such as intrauterine insemination and in vitro fertilization (IVF), to achieve fertilization and pregnancy.
Treatment with antibiotics may be prescribed if a man is found to have an infection or inflammation in any of the organs associated with sperm production or transportation. Such infections can lead to decreased fertility.
It is possible to correct a varicocele with a surgical procedure called varicocelectomy or varix ligation. During this procedure, a small incision is made in the groin area and the enlarged veins are tied off. This procedure is performed on an outpatient basis. The success rate following treatment results in improvement in up to 70 percent of men, with a 35 percent to 40 percent unassisted pregnancy rate.
Correction of obstruction, whether from vasectomy (vasectomy reversal) or other factors, results in return of sperm to the ejaculate in 50 percent to 95 percent of men.
Assisted reproductive treatments have revolutionized male infertility treatment. These procedures, which manipulate sperm in a controlled manner, have greatly facilitated pregnancy. The procedures include:
- Intrauterine insemination (IUI) — involves depositing a large number of specially processed sperm into the uterus at the optimal point in the menstrual cycle
- In vitro fertilization (IVF) — involves harvesting eggs from the female partner and combining them with sperm in a carefully controlled laboratory procedure. Once an embryo or embryos form, they are placed in the uterus
- Intracytoplasmic sperm injection (ICSI) — involves injecting a single sperm into an egg. This is a highly specialized technique

Testicular Sperm Aspiration (TESA)

The Reproductive Medicine Center at Froedtert & The Medical College is the only program of its kind in the Milwaukee area offering a minimally invasive procedure for men called testicular sperm aspiration, or TESA. TESA is performed by a urologist using a local anesthetic, a small needle and a special syringe to extract sperm directly from the testicles to be used for diagnosis and/or sperm freezing.

Costs

Certain diagnostic procedures and treatment services may be billable to health insurance.

Packaged pricing is available for various services. We will be happy to discuss our charges and services that may be covered by insurance.

More Information

We will be happy to answer your questions related to male infertility. Please contact us.

Additional information about male infertility is available at maleinfertility.com

Glossary

Electro-ejaculation — using a special machine, an electrical probe is inserted into the rectum; a current generated by the machine stimulates the nerves and produces contraction of the pelvic muscles, resulting in ejaculation; semen is collected and may be used with various assisted reproductive treatments
Epididymis — a structure within the scrotum attached to the backside of the testis; the epididymis is a coiled segment of the spermatic ducts that stores and transports sperm between the testis and the vas deferens
Morphology — sperm shape, which includes examining the sperm head, midpiece and tail
Motility — a sperm’s ability to move
Scrotum — a pouch of skin which contains the testes, epididymides, and lower portions of the spermatic cords
Seminal vesicle — a structure about 2 inches long that contributes fluid to a man’s ejaculate
Testicles — the male reproductive glands and the source of sperm and androgens (male sex hormones), located in the scrotum
Testicular torsion — within the scrotum, the testicles are secured at either end by the spermatic cord; the cord may become twisted around a testicle, cutting off the blood supply to the testicle; this may result from an injury to the testicles, from strenuous activity, or for no apparent reason
Testosterone — a male sex hormone produced by the testes that encourages the development of male sexual characteristics
Varicocele — dilation or swelling of the veins that drain the testicle
Vasal aspiration — a procedure for men who have blocked or absent vas deferens or who have had a vasectomy; immature sperm are surgically removed from the epididymis (through an incision in the scrotum) and cultured in a laboratory, then used in an IVF procedure with the female’s egg
Vas deferens — the main duct through which semen is carried from the epididymis to the ejaculatory duct
Vasectomy — a surgical procedure designed to make a man sterile by cutting or blocking both of the vas deferens tubes through which sperm pass into the ejaculate
Vibratory stimulation — a device designed to achieve ejaculation in a man with spinal cord injury; a mechanical vibrator is placed under the tip of the penis and set to vibrate; the vibration travels along the sensory nerves to the spinal cord and may induce a reflex ejaculation; the results depend on the level of the spinal cord injury