Male Infertility

Since the 1970s, both sperm quality and quantity have decreased by more than 50%. This reduction is occurring independently of increasing age, which is the primary factor for decreased fertility in older women. Additionally, the average age of men who first enter fatherhood has increased rapidly worldwide since the 70s. Therefore, it’s no wonder that the primary cause of around 70% of couples experiencing infertility is due to reduced or inadequate sperm analysis results.

Sperm quality and quantity can be assessed through sperm analysis. If the sperm count is only slightly reduced, then sperm can be injected directly into the uterus using artificial insemination to “help” the sperm on their journey to reach the egg cell. This provides the sperm with a sort of “shortcut” to the fallopian tubes where the egg cell is located and therefore increases chances of pregnancy. If the results of the sperm analysis indicate a very limited number or decreased quality of sperm, then treatment with IVF or ICSI can be initiated. In IVF, the semen and the egg cell are combined in a petri dish, which allows for spontaneous fertilization to occur. However, IVF requires adequate sperm density and sufficient sperm motility. If sperm density is too low, sperm motility is reduced, or the semen contains mainly malformed sperm, then patients can receive treatment with ICSI (intracytoplasmic sperm injection). This method requires the selection of a single, vital sperm, which is then is then injected directly into the egg cell. The selection of the ideal sperm for ICSI is usually based on sperm motility and microscopic appearance. When sperm make their way through the female reproductive tract, they have to overcome a series of obstacles before they can reach the egg, creating a natural selection process. This process can be imitated when choosing an optimal sperm for ICSI.

In PICSI (physiological ICSI), a natural, biological method is used to identify ideal sperm for fertilization. Sperm that are capable of binding to a hyaluronic membrane similar to the membrane that vital sperm would have to penetrate in order to fertilize the egg cell, are identified in PICSI and can be used for fertilization. Another possible method for sperm selection is CHIPSI. In CHIPSI, the semen is placed directly into a microchip that is biochemically and physically similar to the female reproductive tract. Sperm that reach the other end of the microchip in a set timeframe can then be used for fertilization. This method can also be used for the selection of semen in IUI (intrauterine insemination). A combination of both PICSI and CHISPSI can be used in order to identify the fittest and most-fertile sperm.

If absolutely no sperm can be identified in the ejaculate, or if the patient has previously received a vasectomy, then testicular puncture is necessary to retrieve viable sperm. During brief narcosis, testicular tissue is gathered using a thin needle. If enough sperm required for fertilization are retrieved, then it’s possible to freeze the extra material.

Especially in men, a change in lifestyle can positively influence sperm analysis results. A reduction in —or better yet, completely quitting—smoking can lead to a drastic improvement in all three sperm parameters. Additionally, a change in diet and taking vitamins and micronutrients can lead to an improvement.

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