Male Factor Infertility

A couple’s infertility can be due to female factors, male factors, or a combination of the two. Most types of infertility due to female factors can be overcome by in vitro fertilization (IVF). Even the most severe cases of male factor infertility can be treated successfully with IVF in conjunction with intracytoplasmic sperm injection (ICSI). ICSI involves microsurgical injection of a single sperm into the egg by an embryologist. Sperm from infertile or subfertile men are obtained from ejaculates, epididymal aspirates, or testicular biopsies.

There are numerous etiologies for male infertility. While some causes are identifiable, others are not. In the last decade, advances in reproductive medicine have helped identify certain genetic causes of male infertility. These genetic causes are most relevant to men with extremely low sperm counts (< 5 million sperm per milliliter, or severe oligospermia) and those who have no sperm (azoospermia). Men with severe oligospermia or azoospermia are at increased risk of having a genetic abnormality when compared to men with normal sperm counts. These genetic abnormalities are important because they can be passed on to the next generation if ICSI is used successfully for treatment of the affected individual’s infertility.

If the male patient under treatment has a chromosomal abnormality, his offspring from ICSI may be completely normal, experience infertility later in life, carry the same chromosomal abnormality, and/or be at risk for genetic diseases such as cystic fibrosis (CF). In fact, 17 to 67% of infertile men may be a CF carrier. While the majority of children conceived through ICSI involving men with low sperm counts are chromosomally normal, studies conducted worldwide suggest that offspring from ICSI conceptions are at increased risk for chromosomal abnormalities.

Couples with severe male factor infertility are strongly encouraged to seek genetic counseling before embarking upon IVF or ICSI. Genetic counselors are available by appointment at the National Naval Medical Center (NNMC) in Bethesda, Maryland. If you are interested in speaking with a genetics counselor, please contact a member of the nursing staff at the ART Institute of Washington for a referral.

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