Disease A - Z > Male Infertility FAQ > Homeopathic treatment for Infertility
In 60% of all couples experiencing infertility, a male factor is involved. It is primarily a male factor in 40% of these couples and in an additional 20% of these couples, it is a combination of male and female factors. Therefore, when a couple is having trouble conceiving it makes sense not only to evaluate the woman but to evaluate the man as well.
Sperm takes three months to produce and mature and there is often a 4-6 month delay between treatment of the man and resulting changes in the sperm. Since the evaluation of the woman may take several months, it is recommended that a comprehensive and accurate semen analysis be scheduled at the outset in order to evaluate the male partner. Treatment of the man can then occur at the same time as treatment of the woman and there will be no additional delay once the womanís treatment is completed
Varicoceles are dilated veins in the scrotum, (just as an individual may have varicose veins in their legs.) These veins are dilated because the blood does not drain properly from them. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on the sperm production. This condition is the most common reversible cause of male factor infertility and may be corrected by minor outpatient surgery.
Most experts do this microscopically to preserve the arterial supply and lymphatics. A sub-inguinal incision (about 1 inch above the penis and 1 inch from the midline) is usually used, as this avoids incising the abdominal muscles and creates less post-operative pain
If the seminal fluid is very thick it may be difficult for the sperm to move through it and into the womanís reproductive tract. Often the semen can be processed to separate the moving sperm from the surrounding debris, dead sperm and seminal fluid. The processed sperm is usually placed directly inside the uterus with a small tube (catheter). This is called intrauterine insemination (IUI)
Sperm carrying ducts may be missing or blocked.
A patient may have bilateral (both sides) congenital (from birth) absence of the vas deferens.
He may have obstructions either at the level of the epididymis (the delicate tubular structure draining the testes) or higher up in the more muscular vas deferens. He may have become mechanically blocked during hernia or hydrocele repairs. He may have become blocked by scar tissue as a response to an infection.
Sperm are stored in sacs called the seminal vesicles and are then deposited in the urethra which is the tube through which men urinate and ejaculate. The sperm must pass through the ejaculatory ducts to get from the seminal vesicles to the urethra. If these are blocked on both sides no sperm will come through.
In some situations the ducts may be repaired or unblocked, to allow them to flow throught the man's reproductive tract. If this is not possible, the sperm may be harvested, but because they are obtained in lower numbers, they must then be used in conjunction with advanced reproductive techniques to attempt a pregnancy
Men can develop an immunologic response, (antibodies) to their own sperm. The causes for this may include testicular trauma, testicular infection, large varicoceles or testicular surgery. Sometimes there are unexplained reasons why this occurs.
These antibodies have a negative effect on fertility although the exact reason why this is the case is unclear. Most likely these antibodies act negatively at several points along the pathway to fertilization. They make it more difficult for the sperm to penetrate the partnerís cervical mucous and make its way into the uterus. They make it more difficult for the sperm to bind with the zonapellucida (the external membrane or shell of the egg). Also, the antibodies make it more difficult for the sperm to fuse with the membrane of the oocytes (eggs) themselves.
The treatment for anti-sperm antibodies is somewhat controversial. Men may be treated with corticosteroids. However, this can lead to significant morbidity in the man. The most significant is aseptic necrosis of the hip (noninfectious destruction of the joint) requiring hip replacement.
Most of the time, the first level of intervention includes intra-uterine inseminations. If the couple is planning invitro fertilization, (IVF) the presence of anti-sperm antibodies is usually an indication to inject the sperm directly into the egg (ICSI) instead of conventional IVF
About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Many men will have difficulty with erections under the pressure at trying to achieve a conception. These couples can easily learn the technique of self inseminations. Studies have shown that 5 out of 6 previously fertile couples having intercourse four times per week will conceive over six months, while only 1 out of 6 with intercourse once per week will conceive during the same period.
This generally refers to the inability of the sperm producing part of the testicle (the seminiferous epithelium) to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons. The testicle may completely lack the cells that divide to become sperm (ďSertoli Cell-Only syndromeĒ). There may be an inability of the sperm to complete their development (" maturation arrest"). Sperm may be made in such low numbers that few if any successsfully travel through the ducts and into the ejaculated fluid (hypospermatogeneses). This situation may be caused by genetic abnormalities, hormonal factors, or varicoceles.
Even in the case where the testes are only producing low numbers of sperm, the sperm may be harvested and used in conjunction with advanced reproductive techniques to attempt a pregnancy
Cryptorchidism may be a cause of testicular failure. When a baby boy is born without the testes having fully descended into the scrotum the condition is known as cryptorchidism.
Since the testes are very sensitive to temperature, if they do not descend into the scrotum prior to adolescence, then they will stop producing sperm altogether. In fact, they have a higher rate of malignancy. The current recommendation is that at approximately one year of life, if they have not yet descended by themselves, they be brought down surgically.
Cryptorchidism is often associated with male factor infertility. 81% men who have a single testis that is cryptorchid have normal fertility. However, approximately only 50% of men who have bilateral cryptorchidism have normal fertility. This may be due both to something inherent in the testes, to the surgery, or to the damage done by not having brought the testes down in time
There are a number of fairly common drugs, which may have a negative effect on sperm production and or function. They include:
The following list of drugs can cause ejactulatory dysfunction:
The testicles need pituitary hormones to be stimulated to make sperm. If these are absent or severely decreased the testes will not maximally produce sperm. Importantly, men who take androgens (steroids) either by mouth or injection for body building shut down the production of hormones for sperm production.
A hormonal profile must be performed on all men with male factor infertility. This will help rule out serious medical conditions, give more information on the sperm-producing ability of the testes, and may reveal situations where hormonal treatment is indicated
Men may have infections of their reproductive tract. These may include infections of the prostate (prostatitis), of the epididymis (epididymitis), or of the testis (orchitis).
Post-pubertal viral infections of the testes may cause significant damage (atrophy) of the testes and may cause absolute and irreversible infertility. Bacterial infections or sexually transmitted diseases may cause blockages at the sperm ducts. The patient may have normal production of sperm, but the ducts carrying it are obstructed.
Active bacterial or viral infections may have a negative effect on sperm production or sperm function. White blood cells, which are the bodyís response to infection, may also have a negative effect on sperm membranes making them less hearty.
If excessive white blood cells or bacteria (more than 1 million/cc) are seen in a semen specimen, cultures should be done. This usually includes cultures for commonly asymptomatic, sexually transmitted diseases including mycoplasma, ureaplasma and chlamydia. Also, a general genital culture is usually taken. If the infection and the white blood cells are persistent then antibiotics may be considered.
It is important to note that in most men the ejaculate is not sterile. In controlled studies, the average man will culture positive for approximately two organisms. It is therefore very important to be judicious in the treatment of non-sexually transmitted organisms found on cultures.
When these conditions are treated, a man will often see a significant improvement in his semen analysis.
There are a number of lifestyle factors that can significantly affect the quality of sperm. Here are several lifestyle changes that men can make when preparing for conception
Smoking and its associated toxins cause a 23% decrease in sperm density (concentration) and 13% decrease in motility (when averages are taken from nine separate studies). To a lesser extent, smoking causes an increased number of sperm with abnormal morphology (shape). Smoking causes toxicity to the seminal plasma (the fluid ejaculated with the sperm): sperm from non-smokers were adversely affected (had significantly decreased viability) when placed in the seminal plasma (hormonal) of smokers
Anabolic Steroids (male hormones)
Moderate alcohol use does not affect male fertility. Excessive alcohol use affects the hormonal axis and is a direct gonadotoxin. It may cause associated liver dysfunction and nutritional deficiencies that are also detrimental for sperm production
Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle
Aerobic and resistance training helps to increase testosterone levels, which leads to increased sperm production. Moderate amounts of exercise can only be helpful
Environments that increase the overall scrotal temperature can have a negative effect on sperm production. Men should avoid the increased temperatures of saunas and hot tubs
The general purpose of a manís evaluation (semen analysis and, if appropriate, a consultation) is to identify any problems and address them in order to maximize the quality of the manís semen. This may reduce the need for more complicated interventions for the female partner. It is also important to rule out significant medical problems that may contribute to a poor semen analysis. Therefore, the most important first step in any manís evaluation is the semen analysis.
Semen is the fluid that a man ejaculates. This fluid is produced at several different sites. The sperm within the semen are the cells that actually fertilize the egg and are therefore the most important to assess. However, the sperm account for only 1-2 % of the semen volume. Problems with the surrounding fluid may also interfere with the movement and function of the sperm. Therefore, both the sperm and the fluid must be tested.
There is no absolute numerical cutoff between the semen analysis of men whose partners will get pregnant and those who won't. The partners of some men with a very poor semen analysis may conceive easily. The partners of some men with an excellent semen analysis may experience difficulty. However, men with good semen analysis results will, as a group, conceive at significantly higher rates than those with poor semen analysis results. The semen analysis will help determine whether there is a male factor involved in the couple's sub-fertility
Almost all laboratories will conduct tests and report on the following information using values established by the World Health Association:
This is a measurement of how many million sperm there are in each milliliter of fluid. There are various techniques for obtaining this number - some prove to be more accurate than others. Average sperm concentration is more than 60 million per milliliter (>60 million/cc). Counts of less than 20 million per milliliter (<20 million/cc) are considered sub-fertile
This describes the percentage of sperm which are moving. 50% or more of the sperm should be moving
This describes the shape of the sperm. The sperm are examined under a microscope and must meet specific sets of criteria for several sperm characteristics in order to be considered normal. Most commercial laboratories will report WHO morphology (i.e. use World Health Organization criterion). 30% of the sperm should be normal by these criteria
This is a measurement of the volume of the ejaculate. Normal is 2 milliliters (2 ccs) or greater. The volume may be low if a man is anxious when producing a specimen, if all of the specimen is not caught in the collection container, or if there are hormonal abnormalities or ductal blockages
This is the number of moving sperm in the entire ejaculate. It is calculated by multiplying the volume (cc) by the concentration (million sperm/cc) by the motility (% moving). There should be more than 40 million motile sperm in the ejaculate
Color, viscosity (how thick the semen is) and the time until the specimen liquefies should also be measured. Abnormalities in the seminal fluid may adversely affect the sperm. For example, if the semen is very thick it may be difficult for the sperm to move through it and into the woman's reproductive tract
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