Around 50% of couples presenting for IVF treatment do so due to male factor infertility.
The causes of male infertility in men presenting for IVF fertility treatment are many and can include lifestyle factors, such as recreational drug use, weight, age and smoking or alcohol intake. There may be problems with a man’s sperm. He may have sperm antibodies or sperm DNA damage. There could be erectile or ejaculation difficulties. Hormone problems also can play a part. But whatever the cause, a diagnosis needs to be made and where possible a treatment undertaken before IVF treatment proceeds.
The IVF treatment process for a male usually begins with a simple semen analysis. A semen analysis is best conducted at a specialist andrology laboratory. An andrologist will check a semen sample for sperm density – there should be at least 20 million sperm per millilitre of semen; Sperm motility or movement – at least half of the sperm in the sample should show forward progressive movement; and sperm shape – at least 15% of the sperm should have a normal shape (head and tail). The andrologist will also look for the presence of sperm antibodies, which if present, should affect less than 15% of the sperm.
If initial results indicate a problem with a man’s sperm, a repeat test is usually run some weeks later. This is because sperm has a life cycle of 72 days. Life experiences such as illness or stress can temporarily affect sperm production quality
The presence of sperm antibodies has been linked to infertility. It has been estimated that as many one in 16 men produce antibodies to their own sperm. They are commonly found in men after vasectomy or injury or infection of the epididymis, though in some cases, there is no explanation.
These antibodies can interfere with sperm motility and fertilisation. A blood test, in conjunction with the semen analysis, can confirm the presence of sperm antibodies. If present, conception is still possible using advanced IVF treatment techniques – namely ICSI (Intra Cytoplasmic Sperm Injection). This is a technique were a single sperm is selected for injection directly into an egg during the IVF treatment process.
The sperm may also be checked for DNA damage prior to IVF treatment. This is accomplished using a recognised test called Sperm Chromatin Structure Assay (SCSA). If a SCSA test detects a significant level of chromatin damage, lifestyle changes and improvement of general health has been shown to improve this. There is also a belief that increasing the ejaculation frequency can help. Some antioxidant supplements have also been shown to be useful though this is not the case with all men.
If the results show that the male has a degree of infertility, how do we treat this? There are not many treatments that will improve the quality of the sperm themselves. There are however a number of treatments available to help the couple to make the best of sperm quality as it is and achieve a pregnancy using IVF fertility treatment.
Few simple drug treatments will increase sperm numbers or make sperm swim or look better. Some men however produce low sperm numbers due to low reproductive hormone (gonadotrophin) levels. Gonadotrophin treatment can help them to produce more sperm in each ejaculate.
Where the semen abnormalities are not too severe the relatively simple IVF treatment procedure of washing and concentrating the male partner’s sperm and inseminating them directly into the uterus of the female is a good place to start.
IVF treatment can be of considerable help in cases of substandard semen quality. The semen is prepared to select the most strongly swimming sperm, which are then placed with the eggs in a knuc dish. This produces fertilisation in about 90% of male infertility cases with the remaining 10% yielding no fertilisation. IVF treatment is often performed for male infertility as, in addition to being a treatment, it is a good diagnostic test of the ability of the sperm to fertilise eggs.