Once considered to be primarily a woman’s problem, infertility is just as likely to be due to problems with the male patient. Because of this, the team at Poma Fertility looks closely at each partner’s history and in most circumstances, treats both the male and female partners. Since male factors account for as much as 40% of infertility diagnoses, a thorough evaluation of the male should be performed early.
Infertility is a team sport. We closely look at both the male and female partner to fully determine any causes along with the best, fastest, and least expensive treatment approaches.
Based on the results of these initial tests, we can determine if male-factor infertility is present, and if so what types of male-factor infertility exist.
We know from experience that both men and women can have a history of being fertile and having children, but suddenly find themselves unable to conceive with no obvious explanation. Using the most thorough testing and the latest treatment approaches, Poma Fertility can determine the exact nature of the problem and assign a specific diagnosis as to where the infertility is coming from. Our decades of experience make it clear that infertility problems often come from the combination of both male and female factors.
Beginning in about 1992, IVF centers began using a technique called ICSI, intracytoplasmic sperm injection, to insert a single sperm into the egg as part of the IVF procedure. If the sperm cannot enter the egg, then IVF alone will not allow fertilization. The proper use of ICSI restores, but does not improve, the normal fertilization rate. Now, men whose sperm is dysfunctional can achieve fertilization of their partner’s eggs just as well as a man with healthy sperm.
Because it can be so effective in helping infertile couples, where the man has dysfunctional sperm, have a child, ICSI is often said to be the second most important fertility treatment after IVF itself.
Our sperm tests help us determine, with a high rate of certainty, whether the sperm will fertilize an egg. For more than 20 years, we have used the Acrosome Reaction Test (AR Test) to accurately determine the likelihood of normal egg fertilization at IVF and normal conception. A normal result suggests that all infertility treatments are possible while an abnormal result suggests that IVF-ICSI technologies are likely necessary.
“When examining patient material in the lab, I never leave anything to chance. This exacting approach gives me direct data in determining what factors in sperm are causing the infertility and what is the best treatment approach moving forward,” Klaus Wiemer, PhD, laboratory director at Poma Fertility.
Accurate use of the AR test has been so effective that our need to use ICSI with IVF has been between 35%-45% whereas, the national average for ICSI use is about 65%. Some IVF centers use ICSI in 100% of cases. The unnecessary use of ICSI may lead to a higher rate of complications for the baby. When the male patient has dysfunctional sperm, the only alternative to ICSI is the use of donor sperm.
By using our web-based patient portal, you can see your blood test and semen analysis results as soon as they are released and reviewed by our staff.. You can print the test report in the privacy of your home.
You will need to schedule a physician consultation follow-up to discuss the implications of abnormal results.
We encourage the AR Test for many of our male patients because the standard semen analysis test results yields less in-depth results on the predictive value for egg fertilization. This is the reason why so many IVF centers use ICSI more often than necessary – they simply do not have a reliable way to predict normal fertilization.
If a man has a standard semen analysis with solidly normal results, then the AR Test will likely add little additional predictive value. If we screen everyone with a standard analysis and then add the AR Test, we will actually increase costs for many of our men who are in our clinic because they have not been able to create the baby they desire. After giving our patients all the information available, we allow our patients to decide whether and when to have an AR Test, but establishing normal sperm function early in the evaluation provides a baseline for determining which treatment approaches will be most effective.
The majority of men with a vasectomy can have more children but they require surgery to reconnect the tubes or IVF with ICSI using sperm from the testicles.
Men who had their vasectomy more than 10 years ago are very likely to have poor quality sperm and require IVF-ICSI even after surgery.
Men who have evidence of testicular atrophy (small testes) are also likely to have poor sperm quality.
Vasectomy reversal surgery offers good success rates over time and the possibility of additional children because the man will continue to produce sperm.
Instead of vasectomy reversal, choosing IVF allows these men to have children because we can aspirate sperm from the testicles under sedation using a needle similar to obtaining a blood sample. We call the technique non-surgical sperm aspiration (NSA). The painless procedure occurs on the day of egg retrieval and is minimally invasive so recovery is virtually immediate.
Men who want only a single child might consider IVF rather reversal surgery followed a second sterilization.
Men who are married to an older woman might also consider IVF because women become less fertile as they age. Conception after surgery can take 6-12 months, which might be a long time if the woman is older than 35.
- Strong family history,
- Developmental issues like undescended testicles
- Medical diseases like diabetes or heart disease
- Past history of cancer drug treatment
- Medications like testosterone replacement or some cardiac drugs
- Recreational drug and alcohol use
- Environmental exposure to chemicals
- Heat such as saunas or hot tubs and occasionally exceptionally hot baths
- Miscellaneous issues like erectile dysfunction
Notice in the following graph that low sperm counts/concentrations are more common in infertile men but fertile men can also have low sperm counts.
If the sperm count is low then the man is more likely to have male infertility. Some fertile men have low counts too.