What is male infertility?
Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. It is defined in practical terms as a couple's inability to achieve pregnancy after a year of unprotected intercourse.
Infertility is a common problem, with more than 5 million couples in the United States dealing with these problems. Infertility affects one in every six couples who are trying to conceive. In at least half of all cases of infertility, a male factor is a major or contributing cause. This means that about 10% of all men in the United States who are attempting to conceive suffer from infertility.
The specialists in Cleveland Clinic's Center for Male Fertility understand your concerns from an emotional perspective as well as the medical one and are here to help. We offer a unique, comprehensive, team approach to diagnosing and treating male infertility to help you achieve your personal goals and dreams for the future. Rapid research advances in the area of male reproduction have brought about dramatic changes in the ability to both diagnose and treat male infertility. The majority of couples suffering from infertility can now be helped to conceive a child on their own.
What causes male infertility?
Conception is a complicated process that depends upon many factors: the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and good embryo quality.
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
Male infertility can be related to a man's inability to produce sperm cells, known in medical terms as azoospermia. Or it can be related to the production of low or poor quality sperm, oligospermia. Other problems that can occur include malformed sperm that cannot live long enough to fertilize the egg and genetic diseases that impair fertility.
The good news is that many cases of male infertility are treatable, allowing couples to achieve their goal of having a family.
Many biological and environmental factors can impact male fertility
What are the symptoms of male infertility?
Besides the inability to conceive children, there are many other issues that accompany male infertility.
Psychological and Emotional Issues
The statistics tell only part of the story about male infertility. It is much more difficult to describe the psychological and emotional impact infertility has on a couple who want to have children. Many times, conceiving a child becomes the total focus of their lives. Feelings of depression, loss, grief, inadequacy and failure are common in men as well as women seeking pregnancy.
Individuals or couples experiencing any of these feelings are encouraged to seek professional help from a counselor or psychologist experienced in dealing with infertility issues. A professional can help you deal realistically with the situation and provide support even while you are going through treatment.
At the Cleveland Clinic Center for Male Fertility, we have the world-class resources of Cleveland Clinic behind us. We believe in a team approach and work closely with mental health professionals who can help each couple cope with their situation in a healthy way.
How is male infertility diagnosed?
Diagnosis begins with a complete physical examination of the man to determine his general state of health and identify any physical problems that may impact his fertility. The doctor also interviews the couple about their sexual habits. If the physical examination and history do not indicate any reason for the couple’s inability to conceive, the next step is to conduct testing to identify the cause of infertility.
For men, we begin with a detailed sperm analysis. Physicians in the Male Fertility Center are among the most experienced in the country in performing in–depth analyses to determine sperm counts, viability (sperm’s ability to survive), morphology (sperm quality and shape) and motility (the sperm’s ability to move to the egg to fertilize it). This information is invaluable in planning the appropriate treatment for each couple. You may also undergo additional tests, including hormone testing to make sure your body is producing the right level of hormones related to fertility and/or genetic testing to evaluate the man’s genetic signature and his DNA.
Women who have not previously undergone infertility testing may be referred to a female infertility specialist in the Cleveland Clinic Ob/Gyn & Women's Health Institute.
Computer-Assisted Routine Semen Analysis
The semen analysis provides the most comprehensive assessment of semen quality and is considered the foundation of the basic infertility workup of a couple. It includes a determination of sperm volume, pH, sperm concentration, total sperm count, percent of motility, velocity, linearity, morphology, color and viscosity.
Our computerized semen analysis system is among the most technologically advanced available and yields extremely accurate, quantifiable results.
Other Testing Available:
- Leukocytospermia quantitation/Endtz test
- Kruger's strict morphology classification
- W.H.O. morphology for sperm assessment
- Special staining for azoospermic specimen
- Semen biochemistry fructose test
- Sperm antibody tests (direct and indirect immunobead)
- Reactive oxygen species
- Sperm DNA assessment
How is male infertility treated?
With modern technology and methods, the number of treatment options for male infertility has expanded. Depending on the cause of infertility, treatment may include:
Medical Therapy for Male Infertility
When sperm production is too low to achieve pregnancy, medication to increase the number of sperm produced is an option. We offer the newest, most effective medications for this problem. For men with low hormone levels, hormone therapy may be required to correct the balance.
We also counsel our patients as needed regarding lifestyle practices that may improve their fertility.
We also offer sperm banking for fertility preservation in men who will be undergoing cancer treatment.
Surgical Treatment of Male Infertility
Depending on the cause of infertility, a surgical procedure may be necessary to correct a defect or remove an obstruction. Our physicians are among the most experienced in the country in surgical procedures to restore fertility. The most common procedures performed here include vasectomy reversal and varicocele repair.
Vasectomy Reversal and Microsurgical Reconstructive Surgery
Vasectomy reversal – a vasovasostomy or vasoepididymostomy – are common procedures that we perform in an outpatient setting. In either procedure, the surgeon reconnects the vas deferens, the tube in the scrotum through which the sperm passes. Viewing the vas deferens through a high-power surgical microscope, the surgeon carefully sews the ends back together.
Blockages in the vas deferens are repaired with a similar technique. The vas deferens is surgically split, the blockage is removed, and the ends of the tube are reconnected. When the original vasectomy was performed many years previously, an additional blockage may have formed in the epididymis, the coiled tube that lies against the testicle where sperm cells mature. Blockage at the epididymis also can occur due to infection or injury. Whatever the cause, the surgeon will fix the problem by bypassing the blockage in the epididymis in a procedure called a vasoepididymostomy.
In Vitro Fertilization
For some couples dealing with male infertility, in vitro fertilization (IVF) is the treatment of choice. Cleveland Clinic has one of the leading IVF programs in the country with excellent success rates. During the IVF process, the ovaries are stimulated with injectable fertility medications to cause multiple eggs to mature. When the eggs are ready, they are collected in a minor procedure.
Fertilization is accomplished by exposing the eggs to sperm in a culture dish, or by directly injecting a single sperm into each mature egg, a process called intracytoplasmic sperm injection (ICSI). After fertilization, embryo development is monitored over the next three to five days, and two to three embryos then are placed into the uterus by way of a small catheter inserted through the cervix.
Intracytoplasmic Sperm Injection
Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection (ICSI) has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile men have the potential to conceive their own genetic child.
In intracytoplasmic sperm injection (ICSI), a single sperm is injected into an egg in a special culture medium. This illustration shows the development of an embryo following fertilization of the egg using ICSI.
Sperm Extraction for In Vitro Fertilization
Approximately 1% of all infertile men are born with the congenital absence of the vas deferens, the “biologic equivalent" of a vasectomy. Unfortunately, there are no artificial tubes that can replace the vas deferens. However, we now are able to help such men conceive using a non-surgical procedure to retrieve sperm from the tiny ducts of the epididymis, freeze them and use them later for in-vitro fertilization (IVF) with the injection of the single sperm directly into an egg.
"Non-obstructive” azoospermia is a condition in which the man does not have sperm in his ejaculation. In about 50% of men with this condition, sperm can be found in the testicles using a microscope. Advances in technology now make it possible to extract those sperm and use them in ICSI.