Infertility: Not Just a Woman's Issue
Dec 13, 2013 12:04PM
● By tina
Sponsored by Fertility Specialists of Texas
Written by Dr. Rebecca Chilvers
About 6 percent of couples of reproductive age are unable to conceive after one year of unprotected intercourse. And in 33 percent of couples where the woman is older than 35, there are fertility problems. Though the age of the egg is the most predictive factor of success for couples trying to conceive on their own or with fertility treatments, having sperm that is able to reach the egg and to subsequently fertilize the egg is essential.
While it is true that the female member of the couple typically will have a more lengthy and involved evaluation, it is critical that the male provide a history and also have a subsequent semen analysis scheduled at his convenience. The semen analysis is the main test for the male patient. During the semen analysis, sperm are evaluated by a skilled technician as to the quantity of sperm present, the shape of the sperm relative to normal and the motility of the sperm in terms of speed and direction of movement.
When a couple is diagnosed with infertility, 35-40 percent of the time there is a predominant male factor involved. Some causes of male factor infertility or subfertility are classified as follows:
1) Erectile or ejaculatory dysfunction: Sperm may be present but cannot reach the woman's reproductive organs.
2) Low sperm count or abnormally functioning sperm: These are the most common causes of male infertility. These findings may be due to causes such as hormonal imbalances, abnormal blood vessel formation around the testicle, failure of the testicle itself to make adequate sperm (due to aging), medication (such as testosterone supplements or anabolic steroids) that as a side effect suppresses production of sperm, a severe infection of the testicles in the past (such as the mumps), severe nutritional deficiency, exposure to environmental toxins (such as heavy alcohol, smoking, or chronically elevated testicular temperature) or past chemotherapy.
3) Absent sperm: This can also be due to hormonal imbalance or blockage of ducts from the testicles to the urethra — from either prior vasectomy (male tubes tied), from a medical condition or genetic disorder (such as cystic fibrosis or Kleinfelter’s) or from past surgery (such as groin surgery).
If the semen analysis is abnormal, sometimes further evaluation is necessary, such as checking hormone levels. If severe sperm abnormalities or absence of sperm is encountered, I may recommend a physical examination be performed by a reproductive urologist, especially if a structural abnormality is suspected. Fortunately, treatments for male factor infertility are pretty straightforward and are usually highly effective.
The two most common treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF) with injection of a single sperm into the egg.
IUI involves obtaining a semen sample from the male, who can provide the specimen at our office or bring it in from home. The sperm are washed and concentrated into a small volume of liquid that is then placed directly into the woman's uterus using a catheter. This allows the sperm to have a head start in reaching the fallopian tube, where fertilization of the egg takes place.
IVF with sperm injection into the egg (also called ICSI) involves retrieving eggs from the woman and then injecting a single sperm into each egg with micro-instruments by our embryologist, who is trained to do this procedure in our specialized laboratory. The number and quality of sperm required for this procedure is much lower than for IUI. One or two of the embryos (the early collection of cells that will make the baby) that result from this process are selected and carefully placed into the woman's uterus. This high-tech procedure results in the highest chances for pregnancy for couples with severe male factor infertility.At my practice, I provide each of my couples with a tailored evaluation. I stress to each couple that both male and female components are critical for success, and therefore, the male evaluation is essential.
Rebecca Chilvers, M.D. is board-certified in Obstetrics and Gynecology and has completed a sub-specialty fellowship in Reproductive Endocrinology and Infertility. She received her undergraduate degree at Baylor University and her medical degree at Louisiana State University Health Sciences Center. She completed her residency and sub-specialty training at the University of Texas Medical Branch in Galveston, where she also earned a Master of Medical Science degree.
In addition to being experienced with in vitro fertilization and fertility treatments, Dr. Chilvers is one of the few women reproductive endocrinologists in North Texas who has received specialized training on the da Vinci Robotic Surgical System, a minimally-invasive option she uses for complex surgical procedures, including myomectomies and tubal reversals. Dr. Chilvers is well-versed in all aspects of infertility and enjoys helping patients with in vitro fertilization, preimplantation genetic diagnosis and fertility preservation via egg freezing.
She and her husband, Dean, currently live in Frisco with their daughter, Natalie.