Despite the gynecological purview of infertility treatment, the significance of the contribution of the male becomes apparent when one considers that approximately one third of infertile couples have a purely male factor cause. Another third are infertile due to combined male and female factors.
Many people, including many physicians, do not appreciate the high incidence of male infertility and consequently, careful evaluation of the male partner is often delayed until testing the female has been completed. Worse yet, evaluation of the male may be abandoned at the first sign of a female abnormality. Contrary to popular belief, even if a man has fathered a child in the past, he may still be infertile in the present. We advocate complete evaluation of both partners in an infertile couple regardless of past reproductive history.
For men with a suspected male factor, we offer consultation and examination to identify contributing factors. Our state-of-the-art andrology (sperm) lab assists us in determining whether the sperm will fertilize an egg without help (allowing natural attempts or insemination) or whether the sperm requires insertion into an egg with IVF and ICSI (intracytoplasmic sperm injection) in order to achieve fertilization.
Our detailed evaluation of the male with sperm function tests such as the acrosome reaction test allows us to tailor the specific treatment necessary rather than requiring IVF & ICSI whenever the sperm quality is poor. Even when IVF is otherwise required, careful evaluation of sperm function can prevent the unnecesary use of ICSI, which in our hands results in lower costs.
We also offer testicular aspiration of sperm for men (a painless outpatient procedure) with an obstruction to sperm ejaculation (such as after a vasectomy). Testicular aspiration offers an alternative to surgery particularly when IVF is necessary anyway or when the female partner is older and the couple does not have sufficient time to attempt pregnancy after a vasectomy reversal.
Download The Male: A Continuing Neglected Factor Among Infertile Couples by Richard J. Sherins, MD