Male Infertility

Evaluation and Treatment of Male Infertility
by Marcus Loo, M.D.

(Excerpt of presentation at 1998 CAMS Semiannual Meeting)

Impaired fertility leads about 15% of all married couples in the U.S. to seek medical attention. In approximately 50% of infertile couples, an identifiable male factor contributes to the problem. A couple is considered to have male factor infertility if the couple has tried and is unable to conceive for over a one year period, and the male has an abnormal semen analysis and/or abnormal sexual function. Therapy for male factor infertility involves applying a treatment that addresses the specific cause of the fertility problem (for example, varicocele, ejacculating duct obstruction or retrograde ejaculation). Although several male infertility problems have been successfully treated, idiopathic infertility often is treated with assisted reproduction techniques such as in-vitro fertilization (IVF). Such techniques provide a chance for conception in some of the most severe cases of male factor infertility , but their application in couples with mild male factor infertility is controversial and costly. The common causes of male factor infertility are: varicocele - 39%, idiopathic - 33%, obstructive - 8%, endocrine (hypogonadoism) - 6%, developmental - 5%, immunologic (antisperm antibodies) - 5%. A varicocele, the abnormal dilation of testicular veins, is seen in 15 % of all men, and in 39% of men with infertility problem. It is a correctable condition. Treatment of varicocele has been controversial because many men with varicocele have achieve pregnancies without treatment of the abnormality. After microsurgical varicocectomy, almost 70% of men will have a significant improvement of their semen analysis and there is a pregnancy rate of about 50 to 60%.

For men with an obstructive etiology of infertility, initial microsurgical reconstruction when possible is recommended over treatment with sperm retrieval and assisted reproduction. Therefore, for the couple considering options for treatment of male factor infertility, evaluation and treatment of the male partner is beneficial to allow identification of conditions that may affect fertility as well as to optimize chances of achieving a pregnancy and live delivery.