Male factor infertility: how strong are your swimmers?
This blog post is written by obstetrician/gynecologist Dr. Madeline Kaye from our wonderful friends at ThreeMDs, a blog that provides easily digestible, evidence-based, and integrative medical information.
It’s pretty amazing all of the things that have to go right to get pregnant: enough eggs, good quality eggs, open tubes, normal shaped uterus, and of course, good swimmers! Infertility is defined as no pregnancy after 12 months of unprotected intercourse, or 6 months if the female partner is over age 35. Problems with sperm (i.e. male factor infertility) are the sole cause of infertility in about 20% of couples and contribute in another 30-40%. There are many reasons why semen may be abnormal, some of which can be corrected.
So how do we know if your sperm is normal? We start with the semen analysis. First, you will collect a specimen of your swimmers - this can usually be done in the comfort of your own home these days (your OB/Gyn, REI, or Urologist can give you a collection cup). You will likely be instructed to maintain 2-5 days of abstinence before collection, and the specimen should be kept at room temperature and brought in to the clinic within 1 hour.
Once your sample reaches the lab, your sperm is analyzed for the following:
Ejaculate volume: total volume of collection. Normal is >1.5mL.
pH: acidity of sperm. Normal is >7.2.
Sperm concentration: number of sperm per mL. Normal is >15 million/mL.
Total number of sperm: calculation of concentration x volume. Normal is >39 million/ejaculate.
Motility: how well the sperm moves. Normal is >40%.
Morphology: shape of the sperm. Normal is >4%.
If your semen analysis is mildly abnormal, you may be asked to just repeat it in a few months after a few minor lifestyle modifications (lay off the reefer maybe?). If there are any abnormalities that are far from normal, you will likely be referred to a Urologist for further evaluation.
This workup may include a full medical history, physical exam, bloodwork, further semen testing, urine testing, and ultrasound. The following are some common causes of male infertility:
Medications and toxins: Testosterone, steroids, narcotics, Propecia/finasteride (hair loss drug), antibiotics and antifungals are some of the common prescription medications that can negatively affect your sperm. Heavy alcohol use, tobacco, and marijuana are also known to decrease sperm production and quality. If you have a job in which you are exposed to a large amount of chemicals or toxins be sure to discuss this with your doctor as well.
Endocrine disorders: Your hormone levels may be off. There are many versions of this and bloodwork is used to diagnose which imbalance you might have and why.
Anatomical abnormalities: Your ejaculatory duct may not be open so sperm cannot get out. One of the more common causes of this is Congenital Bilateral Absence of the Vas Deferens (CBAVD). Another common anatomic abnormality is a varicocele, which is enlargement of the veins in the scrotum which leads to decreased production of sperm.
Genetic abnormalities: You may have changes to the Y chromosome which affects sperm production.
So what happens if you have abnormal sperm? Well, it depends on the cause. If there is an underlying cause that is reversible, you will want to treat that. Sometimes your doctor may not be able to identify a specific cause, or the cause may not be reversible. In these cases, if your semen analysis only has mild abnormalities, you may still be a candidate for intrauterine insemination (IUI). This is when your sperm is concentrated into a small sample and then inserted into the uterus of your partner/gestational carrier. If your sperm count is very low, you may need to do IVF with Intracytoplasmic Sperm Injection (ICSI). This is a procedure in which one good sperm is identified and then injected directly into an egg to hopefully grow into an embryo. In rare cases, there are no healthy sperm and you may need to consider using a sperm donor to help achieve a pregnancy.
Happy swimming!
Love from your favorite vaginista,
Dr. K
