Statistics show that up to 50% of infertility problems among individuals or couples can be traced to male medical conditions. Because of this, it is important for men to be tested as soon as they realize they are having fertility issues. Heartland Fertility can help determine the cause of infertility and suggest an effective treatment plan to help overcome it.

Evaluation of the Issue

The following exams can help determine the cause of the fertility issue:

Urological Exam
This physical exam is instrumental in identifying a wide variety of fertility problems. The urologist starts by assessing the size of the testicles and examines the scrotum and the rectum to evaluate the prostate and seminal vesicles.

Semen Analysis
Performed at the beginning of the fertility treatment during the general work-up, this exam requires that a sperm sample be obtained through masturbation. The spermogram is a basic test used to examine the quality of sperm contained in the ejaculate as well as its consistency. It is also used to determine the number of sperm (count), the proportion of moving sperm (motility), their ability to move forward (progression) and the number of abnormal sperm (morphology).

Hormone Levels
Hormones are complex chemical substances, synthesized by an endocrine gland, that circulate in the body’s fluids. They trigger or control organs or groups of cells located elsewhere in the body.

  • FSH (Follicle Stimulating Hormone) stimulates the development and maturation of Graafian follicles in a woman’s ovaries and spermatogenesis in men.
  • Testosterone stimulates the development of male sex characteristics.

Testicular Biopsy
This examination consists of taking a sample, under local anesthesia, of a small fragment of the testicle. The cells from this small fragment are then examined under a microscope.

Causes of Male Infertility

The causes of male infertility are numerous and not always easy to identify. In some cases, infertility can stem from an obstruction in the male genital tract or from a lesion. In other cases, it may be due to low sperm count, poor sperm motility or abnormal shape.

Azoospermia is defined by the absence of sperm in the ejaculate.

Oligo-astheno-teratospermia (OATS)
OATS is defined as sperm of low concentration, reduced mobility and abnormal morphology. This is not a sterility problem but rather a decline in fertility.

Unexplained Infertility
Some individuals or couples go through all the recommended fertility examinations, but the cause of their infertility cannot be found with tests. More advanced investigations may be needed.

Treatment Options and Possible Solutions

There are many treatment options available for men who experience problems with fertility.

Medical Treatment

  • Antibiotics to treat an urogenital tract infections
  • Hormones in cases where the testicle is not receiving enough stimulation from the pituitary hormones

Surgical Correction and Proposed Solutions through Medically Assisted Procreation

  • Surgery to correct obstructive azoospermia. In this case, the testicles are producing sperm, but they are not found in the ejaculate because of an obstruction somewhere along the path. The surgical procedure identifies the obstruction and then removes it and reconnects the segments.
  • Surgical intervention can be attempted so as to cut away the obstructed area and restore continuity between both segments.
  • Intracytoplasmic Sperm Injection (ICSI): This treatment is only administered to those undergoing In Vitro Fertilization (IVF). It is indicated in cases of severe male infertility in conditions where abnormal sperm movement and low sperm count make it impossible for sperm to penetrate the egg. Using a sample of the spouse’s sperm, the embryologist injects a single sperm captured using a glass needle with a microscopic diameter into each of his partner’s eggs.
  • Percutaneous Epididymal Sperm Aspiration (PESA): This treatment is only administered to those undergoing In Vitro Fertilization (IVF). Done under local anesthesia, this operation is performed when there is an obstruction of the vas deferens. The procedure most often consists of passing a small needle directly into the epididymis, it is sometimes necessary to make a small incision in the epididymis. Sperm is then retrieved and the healthiest are used for IVF microinjection.
  • Testicular Sperm Extraction (TESE): This treatment is only administered to those undergoing In Vitro Fertilization (IVF) with ICSI.  This technique is used in cases where there is a complete absence of sperm in the ejaculate or epididymis and the testicles still produce sperm.
  • Insemination with the spouse’s sperm (AIS).
  • Insemination with donor sperm (AID).
  • In Vitro Fertilization with the spouse’s sperm.
  • In Vitro Fertilization through intracytoplasmic sperm injection (ICSI).
  • In Vitro Fertilization using donor sperm.