Male Infertility

Environmental

Sperm quality can be reduced if the testicles are exposed to elevated temperatures for prolonged periods. The scrotum expands to cool the testicles by moving them further from the body and it contracts to increase the temperature. Activities like prolonged sitting in a hot tub, wearing clothing that is too tight, or occupations requiring long periods of sitting can interfere with temperature regulation and reduce fertility.

Smoking, excessive drinking, exposure to heavy metals, marijuana, chemotherapy, radiation and other factors can decrease fertility. In most cases of environmentally caused male infertility, normal fertility returns once the cause is addressed. Certain heavy metals, chemotherapy, or radiation may cause permanent damage. We advise freezing sperm prior to cancer treatments.

Medical Causes of Male Infertility

Male infertility can be caused by a varicocele, which is a mass of varicose veins in the spermatic cord. Blood circulates through these veins thus cooling or warming the testicles and a varicocele interferes with this function.

A complete evaluation should be done before concluding that infertility is due to a varicocele. Small to moderate varicoceles often don’t have a significant impact on sperm quality. Large varicoceles may decrease sperm quality and can usually be treated by a urologist (surgery for varicocelectomy) or a radiologist (interventional procedure requiring spring placement).

A man may develop antibodies to his sperm (rarely) usually as a result of testicular trauma or a vasectomy. When this occurs, the immune system tries to destroy sperm as if they were bacteria or viruses.

Semen Analysis

The semen analysis is one of the most important fertility tests since up to half of all cases have a male infertility component. Given the extreme importance of ruling out subtle male infertility, it is best to have the analysis done at a reproductive medicine laboratory. These laboratories hire laboratory directors and technicians who are specialists in the evaluation of sperm who usually have years of clinical experience in identifying all types of semen abnormalities.

While a semen analysis can be performed at most hospital laboratories, it is recommended this test be performed at our laboratory so specialized testing can be performed on the same sample.

We have two private rooms for collecting alone or together with a spouse. We will provide instructions on how to collect the sample. It is possible to collect at home or at a nearby hotel using a sterile container or a special condom in certain circumstances. If the sample is collected out of the office, we prefer that it be delivered within 30 minutes of collection. The sample should be kept at body temperature during transit. Special collection condoms can be purchased through our office (less than $15/condom) or they can be purchased through www.INGFertility.com by ordering the “Pre~Seed Semen Collection Kit” that includes: 1 tube “Pre~Seed “sperm-friendly” Intimate Moisturizer” and 1 non-spermicidal Male Factor Condom.

The sample should be collected after two – three days of abstinence, but preferably not more than four-five days unless there is a known history of low sperm concentration. The sample is collected into a sterile plastic container using no lubricants including hand creams, K-Y jelly, Surgilube, saliva, or any others that can interfere with the accuracy of the sample. If a lubricant is necessary, “His~Seed Semen Collection Facilitator” may be used. This lubricant is available through our office.

Sperm require three months to develop so a semen analysis done today is reflective of conditions that affected the sperm during the previous three months.

Kruger Strict Criteria

There are different laboratory criteria for the semen analysis and ours uses the Kruger Strict Criteria for determining the percent of sperm with normal morphology (shape of the sperm). The sample is evaluated as follows:

• Volume – the milliliters (ml) of fluid which comprise the sample.
• Sperm count (technically it is the concentration) is the number of sperm in a standard given volume (ml) and 20 million/ml is considered normal.
• Motility is the percent of sperm that are moving in the sample. Above 50% is considered normal. The percent of sperm swimming forward in straight lines (progressive motility) is also determined.
• Viability is the percent of sperm that are alive. This test using special stains is completed if the percent of sperm that are motile is very low.
• Sperm morphology (shape) using Kruger strict criteria. Greater than 14% normal forms usually predicts excellent fertilization capability in vitro (>60-70%) if the other test parameters are normal.
• Less than five round cells (may be white blood cells which can indicate an infection) per high power field (or 3 million/ml).Factors Affecting Sperm Quality

Factors Affecting Sperm Quality

Sperm are fragile cells and are easily damaged by a number of environmental and life style factors. Increased testicular temperature resulting from sitting in hot tubs, saunas or spas, wearing excessively tight clothing, or other conditions can affect sperm quantity and quality.

Drugs (including alcohol, marijuana and nicotine) have been proven to decrease male infertility and should be minimized or avoided while attempting to achieve pregnancy. Commercial or industrial chemicals such as DBCP, lead, carbon disulphide, benzene, and mercury can have an adverse effect on sperm.

Various pharmacologic compounds have been linked to male infertility by decreasing spermatogenesis (production of sperm) fertilizing capacity:

• Spironolactone (part of many anti-hypertensive regimens)
• Sulfasalazine (treatment of inflammatory bowel disease)
• Colchicine (acute and chronic control of gout and suppression of familial Mediterranean fever)
• Allopurinol (alters uric acid metabolism)
• Anabolic steroids (weight lifters and body building)
• Cyclosporin (component of immunosuppressive regimens used in renal and liver transplant recipients)
• Chemotherapeutic agents (treatment of malignant or cancerous conditions).

Natural Ways to Increase Sperm Quality

• Take a low cost multivitamin to assist with sperm function.
• Try to get 6 to 8 hours of sleep at night.
• Eat a balanced diet and exercise regularly.
• Decrease or minimize caffeine to two cups of coffee a day or no more than two cans of caffeinated beverages.
• Limit alcohol to less than 2 ounces a day.
• Decrease stress in your life as much as possible because stress can have an adverse effect on sperm.
• Avoid all possible gonadotoxins as mentioned above.
• Time intercourse every other day while in the time of ovulation or use ovulation predictor kit testing. For optimal sperm production ejaculation 3-4 times each week throughout the month is optimal. Ejaculation too frequently can reduce sperm concentration and too infrequently can reduce sperm motility.