When a couple seeks help for infertility issues (between 15 and 20 percent of U.S. couples do), it's important to test both the man and woman, according to Cecil Long, MD, physician with the ART Program of Alabama. "Of the couples who seek help, about 40 percent of the problems are related to a severe or significant male factor," he says. And if infertility is bad news, those couples can consider it good news if the problem is discovered to be on the side of the male. "There are several developments in recent years that have all but eliminated male factor infertility," says Long. "Most of the time our treatments will overcome most factors."
If sperm counts are low, inseminations may be required. "If we see less than two million mobile sperm on a semen analysis, then the most practical way to proceed is in vitro fertilization and ICSI, or intracytoplasmic sperm injection."
With ICSI, doctors take a sperm and place it in the egg, which has been harvested earlier from the woman. Even men with extremely low sperm counts can conceive using ICSI. "We need very few sperm to be able to do that. We've even been successful with men who have only a half dozen mobile sperm," says Long. "It's pretty fixable unless the male has absolutely no sperm. That's not impossible, but it's very rare."
Low sperm counts can be the result of genetic disorders, acquired problems such as diseases, or a problem with trauma. Although a biopsy is sometimes performed to determine the exact cause of infertility, it isn't mandated. Some men also choose to have children after a vasectomy, and if a reversal isn't successful or practical, the sperm can be retrieved behind the obstruction where the vasectomy was performed.
In the 19 years that Long has been practicing, he sees a trend toward fertility becoming more "discussable" among men. "It's easier for men to understand that we're a major part in all of this. There's less hesitation today to seek help compared to 10-15 years ago."
Long encourages physicians to include questions about fertility issues when they take a medical history. "My whole slant has been from an ob/gyn standpoint," he admits. "Thinking back when I went through family practice rotations and internal medicine rotations, that was not something that was really promoted. It wasn't one of the top questions, 'Are you and your wife attempting pregnancy or planning on having children?' It's probably something neglected in taking the history of males," he says. "It's routinely asked of females."
One reason for that neglect may be the belief that only women's fertility is affected by age. Since men are continually regenerating sperm, there isn't as marked a decrease in the ability to conceive as with women, but the decrease with age is there nevertheless. "We used to think this is an ongoing, never disrupted process, but what we're finding out is there can be issues as the male ages too. We just don't have it as well defined as in the female. Probably starting after about age 42, there is a marked decrease in the ability to conceive from the male side, and there starts to be an increased chance of congenital abnormalities from the function of the sperm. The male doesn't have forever to be at this constant fertility rate."
Long also reminds other physicians to discuss future fertility with men undergoing treatment for cancer or treatments where there's potential damage to the testes. "The drugs they take can actually produce sterility, so we do encourage men undergoing those types of treatments to consider freezing their sperm. We can freeze their sperm indefinitely. If the oncologist or internist knows that a male is going to be exposed to whole-body radiation or significant chemotherapy, it might be worth their while to have them freeze samples. If you don't freeze them and their function doesn't return, there's not much we can do."
