|How Is Male Infertility Treated?
As there are many different causes of infertility in men, the treatment will depend on the test results you receive. In the majority of cases male infertility is caused by sperm problems, either the man is not producing enough sperm or the sperm he is producing is not of good enough quality. Other causes include hormone imbalances, varicoceles (abnormal veins in the groin area) and obstruction (plumbing problems). In many cases treatment is not necessary. As many as 1 in 5 couples spontaneously become pregnant within 2 years without treatment. If treatment is required, the vast majority of men are treated with conventional therapies like hormone boosting drugs or corrective surgery to repair any blockages or remove varicoceles. In the past, if these methods did not work, there was very little else that could be done. Today, assisted reproductive technologies (ARTs) offer potent new opportunities. ART techniques can help couples become pregnant, even if the man has a very low sperm count.
What Treatment Is There For Low Sperm Count?
If your test results come back indicating a problem in sperm production, there are many different options available to you. But first you may wonder what constitutes good sperm? There are three important factors in sperm production:
Sperm count: The average sperm count should be more than 20 million sperm per ml of ejaculation fluid.
Sperm shape: Known as morphology, the shape of the sperm is important, does it have a regular shaped head or tail?
Fitness level: Known as motility, how fast the sperm can swim and if they move in a straight line.
In general if you have a high sperm count, you are also more likely to have good morphology and motility. If you are tested in a fertility clinic and the results indicate a low sperm count, try not to panic. Semen sample can vary from month to month and can be affected by injury, illness and certain medications. You should check your count again in a month's time. If the count is still low, you should start by making lifestyle changes to try and improve your production levels.
Lifestyle Changes: Improving Your Quality Of Sperm
The aim of any treatment will be to improve sperm quality. The first step is to make lifestyle changes for 3-4 months (it takes 100 days for sperm to develop). This involves:
1. Avoid alcohol, as few as 2 drinks a day can damage sperm quantity. The odd drink is still fine but binge drinking is disastrous.
2. Quit smoking if you smoke, it reduces sperm motility.
3. Avoid stress, it depletes your energy for sperm production. Consider trying acupuncture.
4. Drink 2 liters of water a day, semen largely consists of water.
5. Avoid tight fitting underwear, hot climates and saunas.
6. Eat a balanced diet (Low GI eating plan is excellent) and take a good multi-vitamin. About 35 percent of sperm damage is thought to be caused by free radicals in the body. To protect against free radicals you need to consume more antioxidants vitamin C and E. Foods high in antioxidants are strawberries, blueberries, garlic, plums, red peppers and broccoli.
The following Chinese herbs have been used for many years to treat male infertility:
Zhibai Dihuang pills for immunological infertility.
Astragalus membranaceus for low motility.
Gosha-jinki-gan for unexplained infertility.
Hochu-ekki-to aids unexplained infertility.
Hachimi-jio-gan for unexplained infertility.
After 3 months, have another sperm test (see male fertility tests). If the sperm quantity remains low, ART is usually considered next.
Higher Tech Fertility Treatments
1. Artifical Insemination, also known as Intrauterine Insemination (IUI): Sperm is extracted from the man and is 'washed' so that the best sperm survive. When the woman ovulates, the sperm is injected directly into her womb to reduce the distance it has to travel as much as possible. Hopefully it meets her egg and fertilizes it. The woman usually takes fertility drugs to increase the number of eggs she releases.
2. IVF (In Vitro Fertilization): IVF allows fertilization to take place in a lab. It is also used if there are male tubal blockages and unexplained infertility. With this process the woman's eggs are extracted and mixed with extracted sperm from the man in a lab. The fertilized egg(s) is then placed into the woman's womb. If the man's sperm quality is particularly bad, ICSI may be used to improve chances of fertilization. Read about IVF success rates.
3. ICSI Procedure (Intracytoplasmic Sperm Injection) is performed in conjunction with IVF. A single sperm is injected directly into the woman's egg in a lab. This procedure is performed by an embryologist using a highly powerful microscope.
4. Extracting sperm for IVF (sperm aspiration): If there is little or no sperm in the ejaculation fluid, it can sometimes be extracted directly from the testes. Sperm aspiration involves a minor surgery performed under local anesthesia. If sperm is successfully extracted, it will be used for ICSI or IUI. The surgery is performed in a number of ways and may be referred as MESA, TESA, TESE or PESA.
5. Sperm Donation: If all other procedures fail, the couple may use a sperm donor. Donor sperm can be obtained from sperm banks.
Treating Hormone Imbalances
Although hormone problems tend to be associated with female infertility, they also account for up to 5 percent of male infertility. Low levels of male sex hormones, including FSH (follicle stimulating hormone), LH (luteinizing hormone) and gonadotropin can interfere with sperm production. Medically this is called hypogonadotropic hypogonadism. Treatment can involve being injected with hormones several times a week for up to 6 months. Although not particularly pleasant, the success rates are high. If you suffer from low gonadotropins you may be given anti-estrogen drugs like tamoxifen (Nolvadex) or clomiphene (Clomid) to boost production. Men with high levels of prolactin (which can cause abnormal shaped sperm) may be prescribed bromocriptine. If testosterone production is low it can be boosted with synthetic testosterone via injections, oral pills or transdermal patch or gel.
When Is Surgery Necessary?
If there are 'plumbing' problems surgery may be recommended to unblock and fix the problem. What is nice about surgical treatments is that they can 'cure' infertility without the need so resort to a lab for conception. Common surgeries include:
Varicoceles are enlarged veins (like varicose veins) in the scrotum. The effect of varicoceles on male fertility is highly debatable, although some doctors feel it is the leading cause of infertility. Surgery is performed on an outpatient basis under local or general anesthesia. A small incision is made in the groin and the offending vein is tied off. Recovery can take up to a month. Varicoceles can also be treated with radiographic embolization, which is slightly less invasive. In the past varicocele repair was a common surgery, but because studies have not been able to demonstrate its effectiveness, it is only usually performed today on very large veins. It takes up to 4 months before sperm count shows an improvement.
The same procedure that is used to reverse a vasectomy can be used to treat blockages in men with no sperm count due to past sexually transmitted diseases (STDs), trauma or unexplained blockages. Microsurgery, a special type of surgery technique, can be used with vasectomy to successfully clear blockages caused by a hernia, cysts or stones in ducts. About 7 percent of male infertility cases are caused by blockages in the reproductive organs. The other option to consider is sperm aspiration, which studies show is less painful and requires much less healing time. Sperm aspiration is usually the treatment for retrograde ejaculation (if it is not caused by medications like blood pressure drugs or diabetes medications; in this instance changing medications may cure the problem).
Infections: If a blood test reveals that you have a high number of white blood cells, you may have an infection in your reproductive tract. Taking antibiotics may clear this, but it does not always restore fertility.
Erectile Dysfunction: Sexual intercourse can be problematic if the man suffers erectile dysfunction (problems maintaining an erection) or premature ejaculation (perhaps ejaculating before penetration has occurred). Medications like antidepressants and anti-ulcer drugs may be a cause, or illnesses like diabetes and thyroid disease. If the problem is physical, a change of medication may provide a solution (or a prescription for Viagra). If the problem is emotional, counseling may be recommended. For further information and support see infertility resources.
How does a doctor test for infertility in men?
All about women: Infertility treatment in women.