Testicular function is primarily regulated by two pituitary hormones-FSH and LH. LH regulates the function of a group of cells called Leydig cells, which produce the male hormone, testosterone. FSH regulates seminiferous tubule function, where sperm is manufactured in the Sertoli cell. It is therefore apparent that sexual function is a separate process from sperm production, allowing a normal libido despite decreased or absent sperm production.
Causes of Male Factor Infertility
Male factor infertility can result from multiple causes. The most common of these is idiopathic, meaning that the cause is unknown. However, in many males, the cause can be ascertained with a testicular biopsy. Deficient production of either FSH, LH or both are less common causes, and absence or abnormalities of either Leydig cells or the seminiferous tubules occasionally occur. In a rare male, excess production of the pituitary hormone prolactin may interfere with sperm production. In males with very low sperm counts, a small proportion have been found to have abnormal sex chromosomes, which may consist of too many or too few sex chromosomes or missing fragments of the Y chromosome, called a deletion. The presence of a varicocoele (dilated veins in the scrotum) on one or both sides may cause infertility in some males. In addition, the presence of anti-sperm antibodies in the male himself or his female partner can result in infertility.
In order to make a diagnosis of male factor infertility, a semen analysis is usually the first step recommended. A semen analysis consists of several parts. The volume should be 2 to 5 ml., and the lower limit of a normal count is twenty million motile sperm per ml. The motility, both the percent of sperm moving and the rate of forward progression, are important parts of a semen analysis. Slow moving sperm frequently do not fertilize eggs, even though the actual count is normal. Morphology, or the shape of the sperm, also is evaluated, and semen with many abnormal sperm forms frequently do not achieve fertilization.
A male with abnormal semen on the initial count should have his analysis repeated at least once since the count may be affected by illnesses that occurred as much as three months before. A normal count usually does not need to be repeated. Some males whom our clinical staff deems necessary can have Intracytoplasmic Sperm Injection (ICSI) in conjuntion with In Vitro Fertilization.
In males with no sperm or very low sperm counts, it is important to do a genetic evaluation to prove or disprove an inheritable disorder. Usually this consists of a karyotype (chromosome analysis) on the male looking for abnormal numbers of sex chromosomes or deletion of some genes on the Y chromosome. Also, males with congenital absence of the vas deferens (the tube leading from the testis to the urethra) are frequently carriers of the gene for cystic fibrosis. If the male is a carrier, it is important that the female also be evaluated so that the couple can be made aware of the risk that children may be affected.
Partnering with Board Certified Urologists
NCCRM also works closely with Board Certified Urologist Dr. Kevin Khoudary. Dr. Khoudary practices at Associated Urologists of NC, PA conveniently located around the corner from NCCRM. He has extensive experience in treating all areas of male factor infertility. In conjunction with his practice, Dr. Khoudary performs procedures both at NCCRM’s office in Cary as well as at his practice.
NCCRM offers sperm storage for men who are going to undergo treatment, such as chemotherapy or radiation for cancer or other conditions. Our laboratory is open seven days a week and we can arrange to freeze your semen sample to preserve your fertility before you have any medical treatments that may affect your sterility. Just call (919) 233-1680 to make an appointment. Also, we can do sperm cryopreservation for males who are going to be deployed. Annual Storage Fee for Semen: $250 plus $50 for each additional cane