Male Factor

Evaluation of the male partner is an important part of the infertility work-up. A complete male history is obtained, and a semen analysis ordered. The semen refers to the liquid that is expelled at the time of ejaculation. The sperm are the moving cells within the semen that have the ability to fertilize the egg. The semen specimen is then evaluated for the following:

At the Center for Reproductive Health, we have a dedicated Andrology Laboratory at both the Christ Hospital, as well as the University Pointe office sites. The Andrology Laboratory is staffed by an Andrology technician, as well as 4 embryologists who are specially trained in in vitro fertilization (IVF) procedures. At both sites, we provide private rooms designed specifically for sperm collection, each with a private bathroom. In the event of an abnormal semen analysis, the male partner can be referred to a urologist who specializes in male infertility for a physical examination and further testing.

Treatment

When a sperm problem exists that cannot be corrected, the basic principle of treatment involves getting the sperm closer to the egg. This can be done by a number of methods: 1) IUI (intrauterine insemination) - involves injection of sperm into the woman's uterus 2) IVF (In Vitro Fertilization) - involves mixing the sperm with the patient's eggs in the laboratory, where fertilization will take place 3) IVF + ICSI (intracytoplasmic sperm injection) - injecting a single sperm individually into each egg in the laboratory to improve the chances for fertilization.

ICSI can be used in cases where there are very low sperm counts/motility/ and/or low percentages of normal appearing sperm (morphology). In some cases where the husband produces no ejaculated sperm, sperm can be directly removed from the testicle or epididymis by a urologist (Testicular or Epididymal sperm aspiration), and then frozen for a future IVF + ICSI cycle. Donor Sperm can be used in cases where there is not even enough sperm for ICSI or in conjunction with IUI in patients with open fallopian tubes.

Sperm Banking

Our Andrology Laboratory also offers sperm banking (cryopreservation or freezing of sperm for use at a later date) for males who are undergoing medical treatment which might make them sterile. This would include radiation or chemotherapy for cancer, surgery of the male reproductive tract, etc. This allows the patient to have a chance for future fertility following their medical/surgical treatment. As previously mentioned, patients who require removal of sperm directly from the testicle or epididymis also have sperm frozen prior to IVF + ICSI.

Patients with PCOS also have problems with resistance to insulin, in addition to their ovulatory problems. Treatment with insulin-sensitizing agents such as Metformin, have been associated with weight loss, improved ovulatory function, and most importantly, a reduced rate of miscarriage in women with PCOS. The current recommendation is to continue Metformin in pregnant patients through the first trimester (12 weeks).

Some patients who receive fertility medication will also undergo intrauterine insemination (IUI), a process by which sperm are specially prepared, and then injected into the woman's uterus in a simple office procedure. This can be done using either husband or donor sperm. Sperm preparation is performed in our Andrology Laboratory by highly trained andrologists, who utilize meticulous specimen handling and quality control measures to ensure safety.