The male infertility is a disease that affects the reproductive capacity of males and can prevent women achieve a natural pregnancy. However, there are various medical treatments as well as assisted reproduction techniques to solve a man’s fertility problems and get him to be a father.
The simplest option would be to try to regain male fertility through natural treatments and leading a healthy lifestyle. If this is unsuccessful, it will be necessary to resort to Artificial Insemination (AI) or In vitro fertilization (IVF) to have offspring.
Causes of infertility in men
The main factors that can alter male fertility are:
- Pre-testicular or endocrine factor: it is produced by a problem in the production and/or release of male hormones that regulate spermatogenesis or the development of male sexual organs.
- Testicular factor: the pathology is found specifically in the testicle, which, for genetic or acquired reasons, does not produce sperm correctly.
- Post-testicular factor: in this case, the problem is caused by an obstruction or blockage in the seminal pathways that lead sperm from the testicle to the urethra.
- Sperm factor: it is infertility caused by alterations in sperm characteristics such as concentration, morphology and/or mobility.
If you want more detailed information on how these 4 factors can affect fertility, we recommend the following article: Types and causes of male sterility.
Medical and natural treatments for male infertility
It is not always possible to medically treat a case of male infertility, because unfortunately there are many situations in which it is irreversible.
Among the cases that can be treated with medication, the majority consists of alterations of the male endocrine system, known as the hypothalamic-pituitary-testis axis. In this situation, it is convenient to perform a hormonal analysis to determine the hormones that are being produced abnormally. However, hormonal treatment may not be the solution for male infertility.
When the problem to achieve a pregnancy is due to an obstruction in the seminal tract, it is possible to resort to surgical treatment. In many cases, through an operation, it is possible to remove the physical blockage that prevents the passage of sperm or, where appropriate, recanalize the vas deferens so that the sperm can exit properly in ejaculation.
In addition to medical treatments, there are natural treatments for male infertility. The most recommended and used are those formed from vitamin complexes and antioxidants such as vitamin E and L-carnitine, which can partially improve seminal quality in less severe cases.
Maca Plant is also widely known as a natural remedy for male infertility. The Peruvian maca favours cell exchange and the transmission of nerve impulses due to its high potassium content.
Finally, most urologists recommend a healthy diet, rich in fruits, vegetables and oily fish with a high content of omega 3 fatty acids, which provide vitamins and antioxidant complexes.
Assisted reproduction and male infertility
When medical or natural treatments fail to remedy the fertility problem in men, it will be necessary to resort to assisted reproduction techniques to have offspring.
Normally, when a couple decides to go to an assisted reproduction clinic due to problems getting pregnant, the infertility doctor performs a series of initial tests to try to find out what is preventing conception.
In the case of women, the most common tests focus on knowing the state of her ovarian reserve as well as ruling out any type of disease or abnormality of her reproductive system.
In men, in addition to physical examination and hormonal analysis, the most common test is a semen analysis to determine the quality of the seminal sample.
Depending on the result of these tests, the doctor will establish the most appropriate fertility treatment. Among them, we find the following:
Artificial insemination (AI)
This assisted reproductive technique is a low complexity of fertility treatment. The semen sample, processed in the laboratory, is deposited through a cannula in the uterine fundus while waiting for fertilization to occur by itself.
- Artificial insemination is indicated in cases of mild infertility. Generally, the seminal sample must meet these criteria:
- REM (motile sperm count) greater than 3 million motile sperm after seminal capacitation.
- Normal sperm morphology according to WHO criteria (> 4%).
- However, these requirements to carry out AI vary depending on the criteria of each clinic.
In vitro fertilization (IVF)
IVF is a much more complex process compared to AI. In addition to ovarian stimulation, a surgical intervention under anaesthesia is necessary to obtain the ovules and the subsequent culture of the embryos generated in the laboratory.
Broadly speaking, in vitro fertilization consists of obtaining the eggs and sperm, putting them in contact so that fertilization takes place and transferring the embryos obtained to the uterus of the future mother.
This technique is indicated in cases of male infertility, where the seminal parameters are more altered compared to AI. For example:
- Oligospermia: sperm concentration less than 15 million / ml.
- Teratospermia: normal sperm morphology less than 4%.
- Asthenospermia: reduced sperm motility.
- Oligoasthenoteratospermia: the combination of the 3 above conditions
- Cryptospermia : sperm concentration less than 100,000 sperm / ml.
Although IVF is indicated for male infertility, it is also the reproductive option for single women who do not have patent tubes or for couples of women who wish to participate both in pregnancy using the ROPA method.
Intracytoplasmic sperm injection is one of the most common techniques used in assisted reproduction. Although it is considered a variant of IVF, the manipulation of the gametes (ovum and sperm) is much greater.
ICSI consists of directly introducing the sperm into the ovum through a complex system of micropipettes. This insertion is carried out by the embryologist himself and selects those sperm with the best characteristics.
Although many clinics use ICSI in the same cases as conventional IVF would be indicated, intracytoplasmic injection is specially designed for the most severe cases of male infertility. Some of the situations are as follows:
Asthenospermia: is a sperm disorder in which the mobility of the sperm is reduced. If these cells are unable to travel to the ovum, despite the other parameters being satisfactory, fertilization is unlikely to occur. By injecting the sperm directly into the egg, we solve this problem.
Azoospermia: it is the absence of sperm in the ejaculate. Since only one sperm is needed to fertilize at least one egg, it would suffice to find some viable sperm in the seminal sample.
ICSI is also indicated when we use semen samples from men with infectious diseases or when we are going to treat with a valuable semen sample, that is, from men who have frozen their semen before a vasectomy or chemotherapy/radiotherapy treatment.
If sperm are not found in the ejaculate, it is possible to obtain them directly from the testicle.
To complete the information we offer you here another article where you can read more in-depth: Intracytoplasmic injection.
As we have discussed previously, there are times when it is not possible to recover sperm in the ejaculate. In these situations, it will be necessary to resort to other complementary procedures such as those discussed below:
- Testicular biopsy: consists of making a cut in the scrotum to directly access the testicular tissue where sperm develop and obtain a sample. This procedure is performed in the operating room and under local anaesthesia.
- Epididymal aspiration: Epididymal aspiration has the same purpose as testicular biopsy, however, the technique is different. In this case, it consists of aspirating the liquid that is stored in the epididymis, an organ located above the testicle, to look for sperm. It also requires surgical intervention.
- Testicular aspiration: it is a process very similar to the previous one. The difference is in the area of aspiration, which, in this case, is the testicle itself.
The aforementioned situations necessarily imply resorting to the ICSI technique since the quantity and quality of sperm recovered would be too low to opt for IVF or AI.
The techniques we have just discussed have different prices. The simplest treatment is artificial insemination, whose price is around € 600-1,400.
In vitro fertilization has a higher cost, although it does not differentiate whether conventional IVF or ICSI is used. Its approximate price is € 3,000-5,000.
In both cases, it must be taken into account that the medication for the stimulation and preparation of the endometrium is not included in this initial price.
Other assisted reproductive techniques
The 3 techniques mentioned above are the basic procedures used in assisted reproduction. However, there are other complementary methods to these that are applied in specific cases of male infertility and that further enhance the effectiveness of conventional in vitro fertilization or ICSI.
Each one of them is detailed in the following sections.
This procedure called IMSI for its acronym in English, Intracytoplasmic Morphologically Selected Sperm Injection is a variant of ICSI. The improvement of the IMSI with respect to the conventional technique lies in the fact that the IMSI uses a microscope with 6000 magnifications, while in a normal ICSI only 400 are used.
This macroscopic magnification allows the embryologist to evaluate the sperm morphology in a much more detailed way to select the best sperm.
This technique is especially indicated in severe cases of teratozoospermia, that is, for those men who have a high percentage of sperm with abnormal morphology in their ejaculate.
The MACS method, Magnetic Activated Cell Sorting, consists of filtering the semen through a columnar system to remove dead or non-viable sperm from the sample. This sperm selection is possible thanks to particles that detect and stop certain cellular components expressed in dead cells.
The MACS technique is indicated for severe male sterility, such as seminal samples with a high degree of sperm fragmentation or for repeated ICSI failures.
This technique, also known as physiological ICSI, is based on the same practice as a conventional ICSI. However, sperm selection is performed prior to microinjection.
This sperm selection consists of depositing the seminal sample on a plate with hyaluronic acid, a molecule present in high concentrations in the cells of the cluster that surround the oocyte. Sperm recognize this molecule thanks to receptors that they contain in the head area.
If the sperm remain attached to the plate, it means that they are able to effectively recognize the oocyte and, therefore, the chances of fertilization taking place are greater.
Questions from users
Besides the Semen Analysis, what other tests are there to detect male infertility?
We can also evaluate seminal quality through the study of the genetic content of sperm. On the one hand, we can study the integrity of DNA, which is essential to achieve correct embryonic development. However, it is sometimes fragmented. The fragmentation test assesses the percentage of fragmented sperm in the ejaculate.
On the other hand, we can study if the sperm have a correct chromosomal content through the FISH study (5 pairs of chromosomes are assessed) or Chromosperm (a general chromosomal profile is assessed). An ejaculate with a high percentage of chromosomally altered sperm could lead to a greater number of aneuploid embryos.
What therapeutic options are there for male infertility?
Male infertility can be of different types and caused by various factors. Depending on the criteria we use, we can classify them in a different way, but they will all be treated.
To detect infertility problems in men, it is only necessary to do a semen analysis. To do this, you just have to obtain the semen through ejaculation. Sometimes a second sample is necessary to perform more specific tests to help make a more accurate diagnosis.
Most semen problems can be corrected. There are vitamin complexes that improve seminal quality enough to achieve pregnancy naturally. Other times these vitamin complexes are necessary to improve the chances of pregnancy to do an artificial insemination treatment or fertilization in case of in vitro treatment.
Is varicocele a cause of male infertility?
Yes, a varicocele can be a cause of male infertility. This pathology can present in different degrees of affection so that its harmful effect on male fertility (mainly causes seminal and hormonal alterations) can be mild to severe.
Can obesity cause infertility in men?
Of course. Different scientists have verified that those men with a body mass index greater than 30 have a poorer semen quality and, therefore, have greater difficulties when it comes to being able to achieve pregnancy naturally.
The reason for this is that overweight men tend to have low levels of androgens, such as testosterone. As a consequence of this decrease in male sex hormones, spermatogenesis, that is, the production of sperm is affected.
Therefore, men with a high BMI may present with oligozoospermia, and alteration of the semen characterized by a low concentration of sperm.
Is male infertility reversible?
It depends on what is the cause that is causing the male to present reproductive problems. For example, if infertility is due to a genetic factor, it cannot be reversed, but if infertility is due to an obstruction in the vas deferens or the taking of a medication that is affecting sperm production, surgical treatment can be applied. or abandon the medication, respectively.
Are there male infertility treatments covered by Social Security?
Yes, it is possible to undergo a fertility treatment for a male through public health as long as the requirements (age, previous children) established by the corresponding health system are met.