Infertility
Male Infertility
Infertility is a sensitive and often trying concern for the nearly one in six couples who have trouble conceiving a child. With 40 - 50% of cases caused by female factors and 40% caused by male factors, infertility affects both sexes equally. The remaining 10-20% of cases are categorized as unexplained infertility. However, it is important to note that even if the cause cannot be diagnosed, treatments can still be successful. There are viable options for most causes of infertility. At HEARTLAND we strive to find a solution that will give you the gift you're hoping for.
Normal Fertility
The same hormones that control ovulation in women also regulate the production and release of sperm in men. Sperm is constantly being produced in men's testicles throughout their lives.
Sperm is produced in the testes. It takes 72 days to mature. It then travels down the epididymis where it is stored.
An egg remains fertile for up to 24 hours from the time it is released. Within five minutes of ejaculation, the sperm travels from the cervix through the uterus to the fallopian tube where the fertilization of the egg occurs. Despite there being hundreds of sperm that reach the egg, only one can penetrate and fertilize it. A fertilized egg stays in the fallopian tube for approximately 4 days during which time it begins to divide. Then it moves into the uterine cavity where it implants itself in the uterus.
Causes of Infertility
Infertility is not a woman's problem. Male factor infertility is now known to prevent about 40% of infertile couples from conceiving. Commonly, male infertility is related to the quality and/or quantity of sperm. Potential causes of male factor infertility are:Age
Though it is not as big an issue for men as it is for women, more studies are showing that age can be a factor in male infertility. As you age you may experience decreased testicular function, hormone levels or sperm production.
Blockage
Blockage is when the tubes that carry sperm from the testicles to the prostate are obstructed or missing. A blockage can result in a low or no sperm count and/or low semen volume. It can even prevent sperm from being ejaculated. Up to 5% of infertile men are affected by blockage.
Congenital Bilateral Absense of the Vas Deferens is a common cause of obstructive azoospermia (no sperm). This is associated with Cystic Fibrosis and the Cystic Fibrosis gene of which there is an increased incidence of this condition here in Manitoba.
Cancer
Sterility is a side effect of many cancer-fighting drugs while chemotherapy and radiation can damage and destroy cells in the reproductive system. Testicular cancer can lead to removing the testicles and therefore cause infertility.
Hormonal Abnormalities
For the body to produce healthy sperm, there must be just the right balance of testosterone and gonadotropin. Abnormal hormone levels create a dysfunction in the interaction between the hypothalamus, pituitary and testicles that can affect sperm production. Such is the case for up to 3% of infertile men.
Diabetes, a thyroid condition or prolactin problems are other hormonal issues that can also result in infertility.
Infection
Untreated infections can adversely affect sperm production or cause structural damage. Sexually transmitted infections (STI's) are the most common causes.
Physical Abnormalities
Physical abnormalities within the reproductive system can prevent the production of healthy sperm. Common abnormalities include:
 | Retrograde ejaculation - when semen is ejaculated into the bladder instead of through the penis. This can be the result of diabetes, removal of the prostate or spinal cord injuries. |
| Undescended testes (cryptorchidism) - if the testes don't descend into the scrotum, they maintain a higher temperature, which reduces sperm production. Often associated with abnormal testes. |
| Varicocele - the result of varicose veins in the testicle. Like undescended testes, it increases the temperature in the testes interfering with the production of sperm. |
| Erectile Dysfunction - If the male partner cannot sustain an erection penetration and pregnancy are not possible. The cause of erectile Dysfunction can be physical or emotional. |
Sperm Issues
Male infertility is often related to the quality and/or quantity of sperm. Fertile men normally produce a minimum of 20 million sperm per milliliter of semen ejaculate. Any less is considered impaired fertility or low sperm count. Non-production of sperm (azoospermia) is the result of testicular failure or when there is a complete lack of sperm. If sperm are incapable of traveling through the cervix to the Fallopian tube, they are considered to have poor motility. Finally, poor morphology or shape can inhibit sperm from penetrating an egg.
Evaluations & Tests
Semen analysis is the most frequently used test for male infertility. It measures the volume of semen being produced as well as the number and motility of the sperm in the sample.
Motility is essential to move the sperm to the fallopian tubes and enable it to penetrate the egg's outer shell-like covering for fertilization. Semen analysis can also evaluate the morphology (shape), pH (acidic level) and white blood cell count. An abnormal assessment in one or more of the above can indicate male factor infertility.
Other specialized tests, which may be utilized, to evaluate male infertility are:
| Swim up semen analysis. |
| Y-Chromosome Microdeletion - will indicate if a portion of the Y-chromosome is missing. |
| Antisperm Antibodies - to determine whether any antisperm antibodies are present. Typically done post vasectomy. |
| Karyotype - done through a blood test, it will determine whether there is an abnormality in the chromosomes that is affecting the ability to produce sperm, e.g. Klinefelters Syndrome. |
| CFTR Gene Analysis - some cases of infertility are genetic. This test will determine abnormalities due to genes such as the one for cystic fibrosis. |
Lifestyle
General health and wellness through a well-balanced diet and lifestyle is very helpful to fertility. Consuming excessive amounts of alcohol can be damaging to sperm. Smoking as well as the use of drugs such as marijuana, cocaine and tobacco can affect fertility by reducing sperm count. Certain prescription drugs such as ulcer medication and anti-malarial drugs are also not recommended. The use of anabolic steroids and the exposure to environmental toxins like printing inks and paint solvents should also be avoided.Timing of Intercourse
To increase your chances of conception, it is recommended that you have sexual intercourse every 2 to 3 days around or during the time of ovulation. For a women with a regular cycle of 28 day to 30 days, this means having intercourse between days 10 and 17, around the time of ovulation. Ovulation occurs approximately 12 - 16 days before the next expected period. Abstaining for more than 3 - 4 days does not increase sperm quality.
