Male infertility is a condition that affects a man's reproductive capacity and may prevent a woman from achieving a natural pregnancy. However, there are several medical treatments as well as assisted reproduction techniques to solve men's fertility problems and make them father.
The simplest option would be to try to restore male fertility through natural treatments and a healthy lifestyle. If this does not work, it will be necessary to resort to artificial insemination (AI) or in vitro fertilization (IVF) to have offspring.
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Causes of Male Infertility
The main factors that can affect male fertility are:
- Pre-testicular or endocrine factor: it is caused by a problem in the production and/or release of male hormones that regulate spermatogenesis or the development of male sexual organs.
- Testicular factor: he pathology is specifically found in the testicle, which, for genetic or acquired reasons, does not produce sperm correctly.
- Post-testicular factor: in this case the problem is caused by an obstruction or blockage in the seminal ducts that lead the sperm from the testicle to the urethra.
- Sperm factor: this is infertility caused by alterations in sperm characteristics such as concentration, morphology and/or mobility.
If you want to learn more about this subject, we recommend you to read this post: What Causes Male Infertility? – Symptoms & Treatment.
Medical & Natural Treatments
It is not always possible to treat a case of male infertility medically, because unfortunately there are many situations in which it is irreversible.
Among the cases that can be treated with medication, most consist of alterations of the endocrine system, known as the hypothalamus-hypophysis testicle axis. Faced with this situation, it is recommended to perform a hormonal analysis to determine which hormones are being produced abnormally, since hormonal treatment of male infertility is not always the solution.
When the problem to achieve a pregnancy is due to an obstruction in the seminal ducts it is possible to have surgery. In many cases, thanks to an intervention it is possible to eliminate the physical blockage that prevents the passage of sperm or, if necessary, to repair the vas deferens so that the sperm can exit correctly in the ejaculation.
In addition to medical treatments, there are natural treatments for male infertility. The most recommended and used are those based on vitamin complexes and antioxidants such as vitamin E and L-carnitine, which can partially improve seminal quality in less severe cases.
Peruvian maca is also widely known as a natural treatment for male infertility. Due to its high potassium content, it favors cellular exchange and the transmission of nervous impulses. One of its most beneficial properties is the reduction of oxidative stress, which acts very aggressively on cells and especially on sperm.
Finally, most urologists recommend a healthy diet, rich in fruits, vegetables and oily fish with high content of omega 3 fatty acids, which provide vitamins and antioxidant complexes.
Assisted Reproduction & Male Infertility
When medical or natural treatments fail to solve the male fertility problem, it becomes necessary to use the assisted reproduction techniques if the man wishes to have children.
Even though assisted reproduction treatments do not allow men to regain their fertility in order to achieve pregnancy naturally, they can help men become fathers by means of the different techniques that exist.
Usually, when a couple decides to go to an assisted reproduction clinic due to problems getting pregnant, the infertility doctor performs several tests to try to find out what prevents pregnancy.
In the case of women, the most common tests focus on finding out the condition of their ovarian reserve as well as ruling out any type of disease or abnormality of their reproductive system.
If you want to know more precisely what these tests consist of, the following post should interest you: Female Fertility Tests.
In men, in addition to a physical examination and hormonal analysis, the most common test is a seminogram to determine the quality of the semen sample.
In order to know better what the seminogram consists of and how it is made, you should read the following post: What Is a Semen Analysis Report?
Depending on the result of these analyses, the doctor will establish the most appropriate fertility treatment. Among them, there are the following:
Artificial Insemination
This assisted reproductive technique is a low-complexity fertility treatment. After processing in the laboratory, a small semen sample is placed inside the uterus with an insemination cannula waiting for fertilization to occur on its own.
Artificial insemination is indicated in cases of mild infertility. Generally, the seminal sample needs to match these criteria:
- MSC (motile sperm count) greater than 3 million motile sperm after seminal capacitation.
- Normal sperm morphology according to WHO criteria (>4%).
However, these requirements for AI may be different depending on each clinic's criteria.
You can find all the information about this technique in the following link: What Is Artificial Insemination (AI)?
In vitro fertilization (IVF)
IVF is a much more complex process. In addition to ovarian stimulation, surgical intervention under anesthesia is necessary to collect the eggs and the resulting culture of the embryos generated in the laboratory.
Basically, in vitro fertilization consists of collecting the eggs and sperm, putting them in contact so that fertilization can take place and transferring the embryos obtained to the uterus of the future mother.
If you wish to obtain more information about IVF, click here: What Is In Vitro Fertilization (IVF)?
This technique is indicated in severe cases of male infertility, where the seminal parameters are most altered. For example:
- Oligospermia o oligozoospermia: less than 15 million spermatozoa per ml.
- Teratospermia o teratozoospermia: less than 4% normal sperm morphology.
- Asthenozoospermia: severe alterations in the motility of the spermatozoa.
- Oligoasthenoteratospermia: combination of the 3 previous conditions.
- cryptozoospermia: less than 100,000 spermatozoa per ml.
Although IVF is indicated for male infertility, it is also the reproductive option for single women who do not have patent tubes or for female couples who wish to both participate in pregnancy using the ROPA method.
ICSI
Intracytoplasmic sperm injection is one of the most commonly used techniques in assisted reproduction. Although it is considered a variant of IVF, as it implies that fertilization occurs outside the woman's uterus, the manipulation of the gametes (egg and sperm) is greater.
At a technical level, it consists of introducing the sperm directly into the egg by means of a complex system of micropipettes.
In order to complete the information provided here you can click on the following link: What Is ICSI Technique?
While a lot of clinics use ICSI in the same cases where conventional IVF would be indicated, intracytoplasmic injection is specially designed for the most serious cases of male infertility. Some of these cases are:
- Asthenospermia: it is a sperm alteration where the sperm motility is reduced. If these cells are unable to reach the oocyte, despite the fact that the other parameters are satisfactory, fertilization will hardly occur. Injecting the sperm directly into the egg solves this problem
- Azoospermia: is the absence of the spermatozoa in the ejaculate. Since only one spermatozoa is needed to fertilize at least one oocyte, it would be enough to find some viable spermatozoa in the seminal sample.
- Testicular biopsy:This procedure involves making a cut in the scrotum to access directly the testicular tissue where the sperm grow and obtain a sample. This procedure is performed in surgery and under local anesthesia.
- Epididymal aspiration: It serves the same purpose as testicular biopsy, however, the technique is different. In this case it consists of aspirating the liquid stored in the epididymis, an organ located above the testicle, to look for sperm. It also requires surgery.
- Testicular aspiration: this process is very similar to the previous one. The difference lies in the area of aspiration, which, in this case, is the testicle itself.
ICSI is also indicated when we use semen samples from men with infectious diseases or when treated with a valuable semen sample, i.e. from men who have frozen their semen before a vasectomy or chemotherapy/radiotherapy treatment.
If no spermatozoa are found in the ejaculate, it is possible to collect them directly from the testicle.
Sperm recovery
As mentioned above, there are times when it is not possible to recover spermatozoa in the ejaculate. In these situations it will be necessary to resort to other complementary procedures such as those discussed below:
The situations mentioned above necessarily imply resorting to the ICSI technique, given that the quantity and quality of the spermatozoa collected would be too small to opt for IVF or AI.
A semen sample is considered valuable when it is difficult for a man to obtain it again, as is the case after this type of treatment.
If you are considering freezing your sperm to have a child in the future, we recommend that you start by creating a Fertility Report. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
Other Assisted Reproduction Techniques
The 3 techniques mentioned above are the basic procedures used in assisted reproduction. However, there are other complementary methods to these that can be used in specific cases of male infertility. They increase even more the effectiveness of conventional in vitro fertilization or ICSI. These techniques are:
IMSI
This procedure, called Intrcytoplasmic Morphologically Selected Sperm Injection (IMSI), is a variant of ICSI. The improvement of the IMSI over the conventional technique lies in the fact that the IMSI uses a microscope with 6000 magnifications, whereas in a normal ICSI only 400 are used.
This macroscopic magnification allows the embryologist to evaluate the sperm morphology in much greater detail in order to select the best spermatozoon.
This technique is especially indicated in severe cases of teratozoospermia, that is, for those men who have a high percentage of spermatozoa with abnormal morphology in their ejaculate.
If you want to learn more about this procedure, we suggest you to read this post: IMSI Procedure in IVF.
MACS
The MACS method, Magnetic Activated Cell Sorting, consists of filtering the semen through a columnar system to remove dead or non-viable spermatozoa from the sample. This selection is possible thanks to particles that detect and stop certain cellular components expressed dead cells.
This mechanism of spermatozoa selection is indicated for men with a high degree of spermatic fragmentation or previous repeated failures with ICSI.
In order to better understand this process we recommend that you read the following post: Sperm Selection Using Magnetic Activated Cell Sorting (MACS).
PICSI
It’s also known as physiological ICSI. The same procedure as in a conventional ICSI is carried out. The difference lies in the fact that, before performing the micro-injection, a special selection of the spermatozoa is carried out.
The spermatozoa are set in a special dish that contains areas with a high content of hyaluronic acid, a molecule present in high concentrations in the cells of the cluster surrounding the oocyte. The sperm recognize this molecule thanks to receptors contained in the head area.
With this technique is assured that these spermatozoa are able to recognize the molecule that covers the oocyte and fuse with it.
We suggest that you read the following article to learn more about this technique: What Is PICSI or Physiological ICSI?
FAQs from users
Besides the seminogram, which tests can detect male infertility?
Seminal quality can also be evaluated by studying the genetic content of spermatozoa. First, we can study DNA integrity, which is fundamental to obtain correct embryonic development. However, sometimes it is fragmented. The fragmentation test evaluates the percentage of fragmented spermatozoa in the ejaculate.
On the other hand, we can study if the sperm have a correct chromosomal content through the FISH study (5 pairs of chromosomes are evaluated) or Chromosperm (a general chromosomal profile is evaluated). An ejaculate with a high percentage of chromosomally altered sperm could generate a greater number of aneuploid embryos.
What are treatment options for male infertility?
Male infertility can be of different types and caused by different factors. Depending on the criteria we use, we can classify them differently, but all of them will be treated.
To detect infertility problems in men, it is only necessary to perform a semen analysis. To do this, it is only necessary to obtain the semen by ejaculation. Sometimes a second sample is needed for more specific analysis to help make a more accurate diagnosis.
Most semen problems can be corrected. There are vitamin complexes that improve semen quality enough to achieve pregnancy naturally. Other times these vitamin complexes are necessary to improve the chances of pregnancy to make a treatment of artificial insemination or fertilization in case of in vitro treatment.
Read more
Is varicocele a cause of male infertility?
Yes, varicocele can be a cause of male infertility. This pathology can present in different degrees of affection. Therefore, its harmful effect on male fertility (mainly causes seminal and hormonal alterations) can be from mild to severe.
Can obesity cause infertility in men?
Yes, it has been scientifically proven that those men with a body mass index higher than 30 have a worse seminal quality and, therefore, present greater difficulties to achieve a natural pregnancy.
In fact, men with excess weight tend to have low levels of androgens, such as testosterone, the hormone responsible for regulating the formation of sperm in the testicles. As a consequence of this decrease in male sex hormones, spermatogenesis is affected and oligozoospermia may appear.
Is Male Infertility Reversible?
It depends on the source of the male's reproductive problems. For example, if the infertility is due to a genetic factor it is not possible to reverse it, but if the infertility is due to an obstruction in the vas deferens or to the taking of a medication that is affecting sperm production, surgical treatment can be applied or the medication can be abandoned, respectively.
Are there male infertility treatments covered by public health system?
Yes, it is possible to carry out a fertility treatment for a male factor through the public health system as long as the requirements (age, previous children) established by the corresponding health system are satisfied.
Suggested readings
If you wish to obtain more information about the tests performed on the man to evaluate the assisted reproduction technique, do not forget to visit this link: Male Fertility Testing - How Do You Know if You Are Infertile?
In addition, if you are interested in the testicular biopsy technique to obtain spermatozoa, we recommend you read the following article: What Is a Testicular Biopsy? - Purpose & Procedure.
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References
G.R. Dohle, T. Diemer, A. Giwercman, A. Jungwirth, Z. Kopa, C. Krausz (2010). Guía clínica sobre la infertilidad masculina. European Association of Urology 2010 (actualización en abril de 2010) (View)
Griffin DK, Finch KA (2005). The genetic and cytogenetic basis of male infertility. Human Fertil;8(1);19-26 (View)
Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. (2001). Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med; 345: 1388-1393 (View)
Juárez de Diego JF (1999). Principales causas de infertilidad masculina. En: Arrondo JL. Actualización en Andrología. Publimed Comunicación SL. Pamplona.
Male infertility best practice policy committee of the American Urological Association (AUA) (2010). The optimal evaluation of the infertile male. AUA Best Practice Statement. Revised,.
Matorras R, Hernández J (eds.) (2007): Estudio y tratamiento de la pareja estéril: Recomendaciones de la Sociedad Española de Fertilidad, con la colaboración de la Asociación Española para el Estudio de la Biología de la Reproducción, de la Asociación Española de Andrología y de la Sociedad Española de Contracepción. Adalia, Madrid.
Pierik FH, Van Ginneken AM, Dohle GR, Vreeburg JT, Weber RF (2000). The advantages of standardized evaluation of male infertility. Int J Androl; 23(6): 340-6 (View)
Sociedad Española de Fertilidad (SEF) (2011). Manual de Andrología. Coordinador: Mario Brassesco. EdikaMed, S.L. ISBN: 978-84-7877.
World Health Organization (WHO) (2000). WHO Manual for the Standardized Investigation, Diagnosis and management of the infertile male. Cambridge: Cambridge University Press.
FAQs from users: 'Besides the seminogram, which tests can detect male infertility?', 'What are treatment options for male infertility?', 'Is varicocele a cause of male infertility?', 'Can obesity cause infertility in men?', 'Is Male Infertility Reversible?' and 'Are there male infertility treatments covered by public health system?'.
Authors and contributors
Hi
I am married for 4 yrs now and we are planning a child for an year now… But unfortunately the things didn’t go in favour. So both me and my partner went for thorough check up. I was diagnosed with OLIGOTERATOZOOSPERMIA with sperm count of 12mil/ml and morphology 3%. Can you tell what should we do? My partner’s reports were all normal.
Hi sir/madam,
My husband (32 years old) has oligoteratozoospermia. We have been married for 3 years. We have visited 5 doctors and everyone has told us that I have PCOS but after checking me for two to three cycles they all told me there was nothing serious, that everything is fine. Then all doctors told me to check my husband. Now he has oligoterazoospermia. What is that mean? Is there any remedy? Could you help me with my queries?
Dear Shamili,
the pregnancy success rates for men having oligoteteratozoospermia depend on the exact values for sperm concentration and sperm morphology; therefore, by “oligoteteratozoospermia” we mean that both sperm parameters (sperm concentration and sperm morphology) are below the normal values.
There exist certain vitamin supplements that may be helpful, but in case the minimum values are not reached, you are advised to start a fertility treatment. Depending on the severity of your husband’s pathology, you will be recommended to undergo intrauterine insemination (IUI) or in vitro fertilization (IVF). Your own values will also be determinant when choosing between the former treatment or the latter.
The following websites may be of interest:
Information about PCOS: polycysticovarysyndrome.info
Information about IUI: intrauterineinsemination.info
I hope I have been able to help
Regards
My testicular biopsy reported oligoteratozoospermia and the semen analysis azoospermia. What can I do now? FSH report 24.
Hello,
If some sperm have been found after the testicular biopsy even though you were diagnosed with azoospermia, you can try with an ICSI.
Best wishes