Wednesday, October 14, 2009

Male Factor Infertility

Male infertility

When a couple has been trying to get pregnant for a long time, the partners often try to figure out the reason for their lack of success. Statistically, the reason involves male infertility about one third of the time, female infertility about one third of the time, and a combination of male and female infertility factors the remaining one third of the time. Consulting with a Reproductive Endocrinology and Infertility expert can significantly help to determine the range of causes and develop an infertility treatment plan.

Male infertility can be due to difficulty in completing intercourse, an inability of the sperm to live within the female reproductive tract long enough to fertilize the egg within the fallopian tube, or a problem with the production of normal sperm.

Difficulty with completing intercourse can be due to an erectile or an ejaculatory problem. Sometimes these problems can be effectively treated with medication. When treatment is not possible, but the man is able to produce a semen sample into a container, then intrauterine inseminations (IUI) that are timed at ovulation are often effective.

The sperm normally fertilizes the egg within the woman’s fallopian tube. There is usually a tremendous decrease in the number of motile sperm along this journey from the initial placement within the vagina (where sperm is usually destroyed within about one hour due to a difference in acidity between the semen fluid and the vaginal vault) to residing within the uterine cervical mucus (where sperm can usually survive comfortably for several days) to passage through the uterus and into the fallopian tube. Generally, it is estimated that if 50 million sperm are placed within the vaginal vault during intercourse only a few thousand of these sperm ever reach the fallopian tube, where they have a chance to fertilize the egg. When this type of male factor is a cause of infertility, then IUI (intrauterine insemination) procedures to place the sperm near the egg at the time of ovulation can be helpful.

The semen analysis is the most common test to determine whether normal sperm are being produced. The major variables that are tested include volume (amount of semen in the ejaculate), concentration (number of sperm per unit volume of semen), motility (percent of sperm that are moving), and morphology (shape of the sperm present). When these numbers fall within the normal range for semen analysis, the sperm is thought to be “good.” But really only a history of proven fertility, such as having achieved a pregnancy with someone in the past or having fertilization at IVF (in vitro fertilization), demonstrates that the sperm is actually capable of fertilizing a human egg. For most mild to moderate male infertility problems involving the production of normal sperm, IUI (intrauterine insemination) is a reasonable treatment alternative. If there is a severe male infertility problem with the sperm, then ICSI (intracytoplasmic sperm injection, which is a form of assisted fertilization) or the use of donor sperm may need to be considered.


Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with male infertility and has personally performed thousands of semen analyses. He would be happy to help you. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at http://www.drericdaitermd.com/or http://www.ericdaiter.com

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Wednesday, January 30, 2008

Male Infertility and Testicular Sperm Extraction

Male factor infertility is accounted for in approximately 50% of couples attempting to conceive. This is attributed to a wide range of factors including stress, excessive use of recreational drugs, hypogonadism, erectile dysfunction, hypospadias, obstruction of the vas defens, oligospermia, and infections. Azoospermia and necrospermia are among the more serious forms of male infertility and generally require infertility treatment in order to achieve a pregnancy.

Men with azoospermia have no sperm in their ejaculate. This is further categorized into obstructive azoospermia, where there is a blockage in the pathway from the testes to the point of ejaculation, and non-obstructive, where there is a problem producing the sperm in the testes. Necrospermia is where the sperm in the ejaculate is dead or lacks motility. These conditions are congenital and cannot be cured. Immotile cilia syndrome is a congenital disorder in which the sperm are actually alive but cannot move. Live sperm that is arrested in development may not be able to be released from the testes, and in these situations advances in infertility treatment, such as testicular sperm extraction, can provide an infertility solution.

The hormones FSH and LH are responsible for sperm production in men, which begins in the testes. Sperm cells go through several phases in the testes and eventually become mature spermatozoa. Spermatozoa leave the testes and travel into the epididymis. It is here where they develop motility and become fully mature sperm capable of fertilizing an egg. It was once thought that no motile sperm could be found in the testes. This has proven true for cases where there is no obstruction in the pathway. When a blockage is present healthy motile spermatozoa have been found in the efferent ducts or the caput epididymis.

Retrieving the sperm is a relatively simple and painless procedure that can be done on an outpatient basis. The skin is stretched out tightly and a small “butterfly” needle is inserted into the testes. Movement of the needle draws out testicular tubules. The needle is withdrawn slowly taking a strand of testicular tissue with it. The tissue is grasped with forceps and gently pulled from the testes. Placed in a culture medium the sample can be examined under a stereozoom microscope for presence of suitable sperm.

The physician will be looking for healthy motile sperm with proper morphology, or shape. Samples don’t often possess enough sperm for intrauterine insemination (IUI), but can work well with intra-cytoplasmic sperm injection(ICSI). ICSI is a microscopic procedure that requires in vitro fertilization, involving the placement of individual sperm cells into individual eggs using a glass needle. The fertilized egg or preimpantation embryo is then transfered into the uterus. The fertilized egg is then inserted into the uterus. While the process is not without risk, ICSI has become accepted as a relatively safe medical procedure.

About the Author: Eric Daiter has been sponsored by The NJ Center for Reproductive Medicine, a leading provider of infertility treatment, to write information about the infertility solution. For more information, please visit www.infertilitytutorials.com

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