Male Infertility and IVF

How Often Are Male Problems Seen in IVF Patients?

How Often Are Male Problems Seen in IVF Patients?

Infertility is defined in men and women who cannot become pregnant after one year of having unprotected intercourse. Studies suggest that after a year of having unprotected sex, 15% of couples are unable to conceive, and after two years, 10% of couples do not have a chance for a successful pregnancy. In couples who are younger than the age of 30 are generally healthy. Hence, 20% to 37% can conceive in the first three months of unprotected sex. 

There are various medical conditions and factors which lead to fertility problems. And, an individual case may have a single cause or a plethora of different causes. Or, in some cases, no identifiable cause is found. Overall, one-third of infertility cases occur through male reproductive issues, one-third by female reproductive issues, and the remaining one-third by male and female reproductive concerns and unknown factors. 

In order to conceive a child, a man’s sperm has to combine with the egg of a woman. The testicles make and store the sperm, which are ejaculated by the penis to deliver sperm into the female reproductive tract via sexual intercourse. The most common problem that leads to infertility in men is issues that affect how the testicles work. Other difficulties include hormone imbalances or blocks in the male reproductive organs. In the majority of cases, the cause of male infertility goes undetermined. 

Does Age Impact Male Fertility?

Everyone assumes that age only matters in female fertility. In fact, men also have biological clocks, but less pronounced. Yes, male fertility does change with age. However, there is no specific age at which a man will conclusively be unable to impregnate their spouse. Pregnancies have occurred in cases of men of virtually all ages.

Sperm counts and sperm quality tend to be impacted by age. Studies have been conducted which have looked into semen quality in normal males and compared it with the quantity and quality of semen in men of various ages. These studies controlled for frequency of intercourse. This is significant since sexual abstinence can lower the quality of semen. Frequent sex creates healthier sperm. Researchers have concluded that semen quantity peaked between the ages of 30 and 35. On the other hand, overall semen quality was the lowest after the age of 55. 

The study also found that sperm motility changed with age. Sperm motility is how well the sperm can swim. Sperm motility was at its best before the age of 25 and the lowest after 55. As a matter of fact, when comparing the number of “good swimming” sperm in men between the ages of 30 to 35 with men over the age of 55, the sperm motility decreased by 54%. These variations could not be associated with differences in sexual abstinence. 

What Is a Normal Sperm Count?

Sperm count is crucial if you are trying to conceive a child. An abnormal sperm count can show that you have an underlying fertility problem. A normal sperm count ranges from 15 million sperms to more than 200 million sperm per milliliter (ml). Anything less than 15 million sperm per mL or 39 million sperm per ejaculation is considered a low count. A low sperm count is commonly referred to as oligospermia. A high or above-average sperm count is over 200 million sperm per ml.

A semen analysis tests for the total number of sperms, their shape, and overall motility. The number, shape, and motility are imperative for testing male factor infertility. I would recommend my patients to test at least three samples of sperm at different visits to gain an accurate analysis.

Have Sperm Counts Been Declining Over the Past Decades?

Men’s sperm have been decreasing in number and are getting worse for some time now. According to recent research, sperm counts are getting worse in the United States and Europe. Studies have determined that American and European men’s sperm count and motility have declined in the past decades. 

An important study was conducted involving over 100,000 men. The percentage of these men whose total modal sperm count (TMSC) totaled more than 15 million had decreased from 85% from 2002 to 2005 to 79% from 2014 to 2017. The percentage of patients whose TMSC came in between 0-5 million increased from 9% to more than 11.5%. 

Studies have been conducted involving over 2,600 sperm donors between ages 19 and 38 in Los Angeles, Palo Alto, Houston, Boston, Indianapolis, and New York City. Researchers confirmed that the total sperm counts, sperm concentrations, and TMSC’s had decreased between 2007 and 2017. 

Many scientists and clinicians believe that sperm counts will continue to decrease in the future. A widely cited study published in 2017 by researchers from the Hebrew University and Mount Sinai’s medical school, studied nearly 43,000 men from North America, Europe, New Zealand, and Australia. They found that sperm counts per milliliter of semen had declined more than 50 percent from 1973 to 2011. And not only that, total motile sperm counts were down by almost 60 percent. Men today are producing less semen, and semen have fewer sperm cells in them. 

There are many possible causes for declining sperm counts in otherwise healthy men. It is reasonable to assume that one of the main factors is the unprecedented amount of chemicals now routinely entering the human body. Many of these toxic substances are called “xenoestrogens.” These are chemical constituents which are foreign to the human body and have the effect of acting as the female hormone, estrogen. Alternatively, xenoestrogens may play a role in promoting the production of female hormone or increasing the effect of estrogen at the cellular level.

What Causes an Abnormally Low Sperm Count? 

Low sperm count proves that the semen you ejaculate during an orgasm contains fewer sperm cells than normal. A low sperm count is a condition known as oligospermia. A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have less than 15 million sperm per milliliter of semen. 

Having a low sperm count decreases the likelihood that one of your sperm will fertilize the egg of your spouse. Nonetheless, men who have mild to moderate decreases in their sperm counts are often still able to father a child. 

The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms that you should look out for. In some men, an underlying problem like an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins, or a condition that blocks the passage of sperm may result in these signs and symptoms. 

The production of sperm is a complex process, and it requires the normal functioning of the testicles along with the hypothalamus and pituitary glands. Once the sperm is produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these symptoms can impair sperm production. 

Sperm abnormalities can be reflected in the sperm concentration (count), shape of the sperm (morphology), and the movement of the sperm (motility). In the majority of cases the cause of these abnormalities remains unexplained. Using the tools of assisted reproduction virtually all male fertility problems can be overcome. In virtually all cases an individual sperm cell is an injected directly into each egg by a process called intracytoplasmic sperm injection or “ICSI.”

At the Infertility and Lifespan Medical Institute we evaluate men who have fertility problems. Our diagnostic evaluation includes a comprehensive semen analysis, as well as blood tests to look at the hormonal functioning of the testicles and pituitary. Dr. Brody provides the most advanced reproductive technologies involving IVF and embryo transfer which are utilized to achieve pregnancy and give birth to a healthy child in almost all cases.

Contact us today for more information at 858-216-2127.

Author
Dr. Steven A. Brody Dr. Steven A. Brody, the Director of the Infertility & Lifespan Medical Institute in San Diego, has spent his professional career providing compassionate and specialized care to help families overcome infertility. Dr. Brody has authored two textbooks, one at Stanford and one with a Nobel Prize winner at Cambridge, entitled “Principles and Practice of Assisted Human Reproduction.” Dr. Brody earned his M.D. degree at Washington University and continued his education with an internship at Yale, a residency at Stanford, and a fellowship at Baylor. Dr. Brody is the only doctor in the U.S. who has achieved Board Certifications in four distinct specialty areas including: Internal Medicine, Endocrinology & Metabolism, Obstetrics & Gynecology, and Reproductive Endocrinology & Infertility. If you are looking for a compassionate and thorough physician who works with you to overcome infertility and treat any reproductive disorders, call the office or book an appointment online today.

You Might Also Enjoy...

Transferring Single Embryos with IVF

Advances in Assisted Reproductive Technology have enabled us to transfer single embryos with IVF. Improvements in all aspects of the IVF process, and changes in the IVF laboratory, have resulted in the growth of embryos with a high rate of success.

Overcoming Infertility with Embryo Transfer

The use of Assisted Reproductive technology, or 'ART,' can dramatically overcome a multiplicity of fertility problems. This success with IVF is due to the proper methodology of egg stimulation, a proficient laboratory, and successful embryo transfer.