Sponsored by Fertility Specialists of Texas
Written by Dr. Rebecca Chilvers
About 6 percent of couples ofbrreproductive age are unable to conceive after one year of unprotectedbrintercourse. And in 33 percent of couples where the woman is older than 35,brthere are fertility problems. Though the age of the egg is the most predictivebrfactor of success for couples trying to conceive on their own or with fertilitybrtreatments, having sperm that is able to reach the egg and to subsequentlybrfertilize the egg is essential.
While it is true that the female memberbrof the couple typically will have a more lengthy and involved evaluation, it isbrcritical that the male provide a history and also have a subsequent semenbranalysis scheduled at his convenience. The semen analysis is the main test forbrthe male patient. During the semen analysis, sperm are evaluated by a skilledbrtechnician as to the quantity of sperm present, the shape of the sperm relativebrto normal and the motility of the sperm in terms of speed and direction ofbrmovement.
When a couple is diagnosed withbrinfertility, 35-40 percent of the time there is a predominant male factorbrinvolved. Some causes of male factor infertility or subfertility are classifiedbras follows:
1) Erectile or ejaculatory dysfunction: Spermbrmay be present but cannot reach the woman's reproductive organs.
2) Low sperm count or abnormallybrfunctioning sperm: These are the most common causes of male infertility. Thesebrfindings may be due to causes such as hormonal imbalances, abnormal bloodbrvessel formation around the testicle, failure of the testicle itself to make adequatebrsperm (due to aging), medication (such as testosterone supplements or anabolicbrsteroids) that as a side effect suppresses production of sperm, a severe infectionbrof the testicles in the past (such as the mumps), severe nutritionalbrdeficiency, exposure to environmental toxins (such as heavy alcohol, smoking,bror chronically elevated testicular temperature)bror past chemotherapy.
3) Absent sperm: This can also be due tobrhormonal imbalance or blockage of ducts from the testicles to the urethra — frombreither prior vasectomy (male tubes tied), from a medical condition or geneticbrdisorder (such as cystic fibrosis or Kleinfelter's) or from past surgery (suchbras groin surgery).
If the semen analysis is abnormal,brsometimes further evaluation is necessary, such as checking hormone levels. Ifbrsevere sperm abnormalities or absence of sperm is encountered, I may recommend abrphysical examination be performed by a reproductive urologist, especially if abrstructural abnormality is suspected. Fortunately, treatments for male factorbrinfertility 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 spermbrinto the egg.
IUI involves obtaining a semen samplebrfrom the male, who can provide the specimen at our office or bring it in frombrhome. The sperm are washed and concentrated into a small volume of liquid thatbris then placed directly into the woman's uterus using a catheter. This allowsbrthe sperm to have a head start in reaching the fallopian tube, wherebrfertilization of the egg takes place.
IVF with sperm injection into the egg (alsobrcalled ICSI) involves retrieving eggs from the woman and then injecting abrsingle sperm into each egg with micro-instruments by our embryologist, who isbrtrained to do this procedure in our specialized laboratory. The number andbrquality of sperm required for this procedure is much lower than for IUI. One orbrtwo of the embryos (the early collection of cells that will make the baby) thatbrresult from this process are selected and carefully placed into the woman'sbruterus. This high-tech procedure results in the highest chances for pregnancybrfor couples with severe male factor infertility.
At my practice, I provide each of my couplesbrwith a tailored evaluation. I stress to each couple that both male and femalebrcomponents are critical for success, and therefore, the male evaluation isbressential.
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.