Causes of Infertility

Male Factor

A common misconception is that infertility is primarily a woman's "problem." In fact, infertility affects women and men equally.

To identify male infertility, a semen sample is analyzed to determine the amount or volume of semen, the concentration of sperm, percent of actively moving sperm and the number of normally shaped sperm. However, a semen analysis alone cannot fully predict a couple’s fertility. At RMA of Philadelphia, we also recommend a complete evaluation of the female partner.

The World Health Organization (WHO) has defined a normal semen analysis as a volume of greater than two cc’s (this is less than ½ teaspoon), sperm count greater than 20 million per cc, and 50 percent motility with 30 percent normal appearance (morphology).

Causes of male infertility include hormonal abnormalities, varicocele (blockage or absence of the duct which carries the sperm from the testes) and difficulty with ejaculation. Often there is no identifiable cause for abnormal sperm production, motility or appearance.

Most men with mild to moderate decreases in sperm count and motility can establish pregnancies through treatment with intrauterine insemination. The semen is washed with special media and the sperm are concentrated. A very thin, flexible catheter with the prepared sample is then placed through the woman’s cervix into her uterine cavity. This very brief, painless procedure places all of the motile sperm in the uterine cavity, close to the entrances to the fallopian tubes, where fertilization can take place.

If the semen analysis is very abnormal, more aggressive treatment is often indicated. In vitro fertilization (IVF) with intracytoplasmic sperm injection, or ICSI, is used in cases of very low sperm count, if sperm do not swim properly or have an abnormal shape that prevents them from penetrating the egg. To perform ICSI, an embryologist injects a single healthy sperm into a mature egg. This process takes less than ten minutes and does not damage either the egg or the sperm.

When there is complete absence of sperm in the ejaculate (azospermia), either due to a blockage or severely reduced sperm production by the testicle, a simple surgical procedure can be used to retrieve sperm to be used in IVF or ICSI. This procedure involves retrieval of the sperm using a thin needle.

Other Causes of Infertility:

• Ovulation Disorders
• Tubal Disease
• Endometriosis
• Diminished Ovarian Reserve
• Fibroids
• Uterine Receptivity
• Recurrent Pregnancy Loss

 

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