| Darline Turner-Lee Physician Assistant | ACSM Exercise Specialist Advocating for Choices in Women's Healthcare |
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New Treatments For Male Factor Infertilityby Darline Turner Lee, Physician Assistant, ACSM Exercise SpecialistArticle Last Reviewed: Sept. 9, 2006Patrick Steptoe, M.D., and Robert Edwards, PhD, spent years perfecting the complex series of techniques involved in in vitro fertilization. Their work culminated in the birth of Louise Brown on July 25, 1978 and ushered in the era of assisted reproductive technology. Until very recently, infertility was believed to be the woman’s fault. Traditional societies blamed infertile women and allowed men to divorce women unable to bear children. Advances in assisted reproductive technologies now help “barren” women have children. These processes also exposed a critical component of infertility-the Male factor. It is now known and widely accepted that a couple is infertile and proper diagnosis and treatment must be initiated on both partners if the couple hopes to have a biological child. According to the American Society for Reproductive Medicine, fifteen percent of couples will be diagnosed as primarily infertile, i.e. they fail to achieve their first pregnancy following a year of unprotected intercourse. Of those couples, 30-40 percent have infertility due to a male factor alone. Therefore, early evaluation of both partners is imperative to give the couple the best chance of conception. “The first step in the male evaluation is a detailed history and physical examination,” says Dr. Kaylen Silverberg, a reproductive endocrinologist at the Texas Fertility Center here in Austin. “We want to know if the man has fathered children from a previous relationship, establishing prior fertility. We inquire about prior surgeries (especially involving the scrotum or genitalia), injuries to the genital area, medications, illnesses and lifestyle habits. Most people are unaware that diabetes is one of the most common causes of impotence damaging the nerves and blood vessels that supply the genitals. Medications, such as those for blood pressure and cardiovascular disease, can cause infertility. Anabolic steroids used by bodybuilders can also cause infertility. We also consider the effects from environmental and occupational exposures, tobacco and alcohol use and recreational habits such as excessive hot tub use on fertility.” The physical examination, performed by the urologist, evaluates the normal development of the genitalia. The size, shape and symmetry of the testes are noted. Evidence of a blockage along the sperm ducts and varicosities on the testes (varicoceles) are noted. Blood levels of testosterone, thyroid hormones, prolactin, follicle stimulating hormone and lutenizing hormone are obtained. An imbalance in any of these hormones can greatly affect sperm production. Essential to the evaluation is the semen analysis. After abstaining from ejaculation for 48 hours, a fresh sample is obtained and analyzed for overall sperm count, motility and normal shape of the sperm. The amount and quality of the seminal fluid is noted. A semen sample is considered normal if there are more than 20 million sperm per milliliter of fluid, if more than 50 percent of the sperm are moving after one hour and more than 30 percent are normally shaped. The seminal fluid should amount to at least two milliliters, not be too thick and fully liquefy within one hour. In the event of an abnormal semen analysis, the procedure is repeated to verify the results. Dr. Silverberg typically obtains a repeat semen analysis in one to two weeks following an abnormal test. The results of the history and physical examination determine the course of treatment. Hormonal imbalances can often be corrected medically. Clomid increases the sperm count in certain cases. If a man has a low sperm count (8-10 million sperm per millimeter) and all other variables are normal, he and his partner can undergo intrauterine insemination (IUI). His sperm is prepared in the laboratory, then introduced into his partner’s uterus. More severe abnormalities in sperm concentration, motility, or normal shape may require in vitro fertilization (IVF) to correct. Dr. Elizabeth Houser, a north Austin urologist, repeats semen analyses after 3 months if abnormal, the time it takes for production and maturation of new sperm. Her evaluation is very similar to Dr. Silverberg’s yet she adds scrotal ultrasound to evaluate for varicoceles. “A varicocele repair can greatly improve sperm count and a couple’s ability to conceive.” Dr. Houser works with many men who have obstructions along the vas deferens, mostly due to vasectomies. Sometimes a vasectomy reversal is possible and for others it is not. Microsurgical Epididymal Sperm Aspiration (MESA) is the way to obtain sperm when there is an obstruction. Dr. Houser has advanced training to do MESA. Via microscopic surgery, she obtains sperm from the epididymis to be used for insemination via Intracytoplasmic Sperm Injection (ICSI) a particular type of in vitro fertilization. To date, all of her aspirations have resulted in live births. “ICSI offers otherwise hopeless couples a chance at conception. ICSI’s are new to Austin but have been done elsewhere for some time.” Both the MESA and ICSI procedures have been done successfully in Austin since 2001 with Drs. Silverberg and Houser and Tom Turner. Tom Turner, PhD. is an embryologist in St. David’s IVF Department. He performs the actual “fertilizations”. The sperm are washed and stored in special medium. Once the eggs are obtained, fertilization is mimicked using microscopic instruments to inject the sperm into the egg. The embryos are then placed back into the woman’s uterus. Research continues into treatments for both female and male factor infertility. As techniques are refined, more infertile couples will be able to have the families of their dreams. The author wishes to thank for their contributions: Kaylen Silverberg, M.D. Reproductive Endocrinologist Elizabeth Houser, M.D. Urologist Tom Turner, PhD, Embryologist |
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