Monday, May 10, 2010

It Takes Two to Tango: Male Factor Infertility (MFI)

Infertility is a harrowing experience for a couple, but while as women we are able to talk about it (albeit within the comfort of anonymous chat rooms), men are often times much more isolated. Historically, being able to procreate often and with various partners is a big part of the male gender identity, so when the semen analysis numbers come back sub par, it's a very tough pill to swallow. And considering that 40 to 50 percent of cases of infertility are due to male factor, that's a lot of men who are silently suffering (2.5 million men every year!).

While some cases of MFI can be treated with lifestyle and dietary changes (you'll have to be patient with those as they take 3 months to see results), most cases are a result of the genetic malformation of the sperm. A basic semen analysis will give you a clear picture of where you stand. Most clinics and/or urologists go by the standards established by the World Health Organization -- below are the parameters:
  • Normal seminal fluid volume (the amount of sperm in the sample) and concentration: 2-6 milliliters  in volume with a minimum of 20 million sperm per milliliter.  
  • Sperm count should be greater than 40 million per sample.
  • Motility (the number of alive and moving sperm) of at least 50 percent.
  • Morphology (correct shaped sperm) of at least 30 percent. Most clinics go by a stricter Kruger test that requires that 12 percent of the sample must have perfect morphology.
In addition to the hard facts of a semen analysis, your partner should see a urologist who will check for physical (e.g. varicoceles) and hormonal abnormalities. He/She will suggest the necessary treatments to help alleviate the issues. Should the examination indicate Azoospermia (no measurable sperm in the semen), micro-surgery can retrieve sperm from the testes and the epididymis (technology is a beautiful thing).

There are a few paths that can present themselves as a result of these tests:

  1. If your partner's semen analysis comes back within the ranges listed above or slightly below, you will most likely get the green light to attempt IUIs
  2. But, if you are dealing with a more severe case of MFI, you will probably go down the IVF with ICSI road, where by the semen is cleaned and the best looking sperms are directly placed inside the oocytes. The 2008 SART member clinics results indicate that 64 percent of IVF cases involved the use of ICSI with 44.4 percent of those resulting in live births. Those are the kinds of numbers that give hope. A piece of practical information I'd like to impart is that if you are going to use your partner's already "fragile" sperm, use a fresh sample rather than a frozen one. Your success rate should be higher as a result of it (it's a different story if you're using donor sperm) -- this is purely anecdotal, but I have personally spoken to women who finally achieved success ones they started using fresh samples. 
  3. A last option, and a difficult one to accept, is to use donor sperm (DS). This a low-tech and low-cost approach, but riddled with many emotional challenges for your partner (and for you) to come to terms with. I'll discuss it soon. Your clinic should be able to direct you to a sperm bank or have donor sperm profiles available to you. 
In upcoming entries I will discuss the emotional aspects of MFI; donor sperm; ICSI vs. PICSI and the bio-ethical conversations surrounding the use of ICSI.


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