Learn more about sperm facts
When evaluating couples who are having difficulty conceiving, it is not uncommon to find that the male partner may have an abnormal semen analysis. In fact, 40% of the causes of infertility are due to the male. It is very important to take a history from the man and get the sperm facts.
Factors contributing to sperm health
Some men use steroids for body building and/or recreational drugs, such as marijuana. Steroids suppress the hypothalamic pituitary area lowering the stimulation of the testicle. As a consequence, sperm production can drop dramatically. This is similar to a woman using an oral contraceptive agent (birth control pill).
Marijuana lowers the production of testosterone and increases the production of estrogen, a compounding negative effect on sperm production. Likewise, smoking has a detrimental effect on sperm function.
If the man is overweight, his excess fat increases the conversion of the male’s testosterone to estrogen, again changing that ratio to an unfavorable situation. Fortunately, these adverse effects are usually reversible. Therefore, changing these habits and improving the man’s health can lead to an improvement in sperm production. This is one of the key sperm facts.
Sperm facts and visiting an experienced urologist
When the evaluation of the semen is abnormal, the man should go to a local urologist for an evaluation. Usually the urologist will perform a “pelvic exam.” This consists of examination of the testicles and a rectal exam to evaluate the prostate gland. The prostate produces approximately 1/3 of the semen (the liquid portion of the ejaculate).
Inflammation of the prostate gland can result in the production of inflammatory white cells. These white cells can result in the development of reaction oxygen species (ROS) in the semen. ROS can interfere with sperm function, even when the numbers of sperm are adequate.
One of the common findings from the examination by the urologist is a varicocele. This is a swelling of the testicular vein in the scrotum, more common on the left. Occasionally, the urologist may recommend that varicocele repair. Some men show an improvement of the sperm motility and morphology. However, some men show no change.
The hormonal evaluation of sperm
Also, it is important for the evaluation of the male to include a hormonal evaluation. A serum FSH and a serum testosterone are critical to ensure that the testicles are functioning properly. If a man has a low serum testosterone with either a low or normal serum FSH, he is a candidate for clomiphene therapy. This is another one of the important sperm facts.
The starting dose of clomiphene for men is 25 mg on a daily basis. In six weeks, we draw a serum testosterone and FSH to determine whether the testicle is responding. If the hormonal response is inadequate, the man takes 50 mg on a daily basis. On the other hand, if there is a response at either level, the medication is continued until conception occurs.
The sperm cycle is 70 to 90 days for men. An improvement in sperm may not be seen for at least three to four months. After six months, usually no further improvement is noted. If there is no response to the higher dose of clomiphene, it may be that this therapy is not going to be beneficial.
More hormone and sperm facts
An elevated serum FSH suggests that the man has testicular failure as the cause of his poor sperm production. Usually the cause of a low sperm count with an elevated serum FSH is genetic. In this situation, it is uncommon that any surgical procedure or hormonal therapy will improve sperm production. Therefore, these guys are not very good candidates for Clomid.
If the quantity of sperm is not too low, these couples may benefit from intrauterine insemination (IUI). However, there needs to be at least 10 million moving sperm following the preparation of sperm for IUI. If the numbers are below that level, then it is best for the couple to undergo in vitro fertilization (IVF). IVF is very successful even with very low numbers of sperm.
When the numbers of sperm are very low, it is common for these couples to need to utilize intracytoplasmic sperm injection (ICSI) during the IVF procedure. ICSI involves injecting sperm directly into the egg in the IVF laboratory utilizing an operating microscope. If the abnormality is so severe that there are no sperm seen in the ejaculate (referred to as azoospermia), some men are candidates for surgical extraction of the sperm directly from the testicle. When sperm are surgically retrieved, the couple needs to undergo IVF/ICSI to achieve pregnancy because sperm obtained surgically are immature and cannot fertilize an egg on their own, even with insemination.
A complete evaluation of the male is important when working with a couple struggling to become pregnant. Occasionally, improving general health and avoiding recreational drugs may be all that is necessary to significantly increase sperm production. Also, there are many available treatment options for couples, even when the male has a very low sperm count.
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