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El Camino Urology Medical Group, Inc
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Male Infertility
General Information and Services Provided
General Information and Services Provided
Fertility problems affect 15-20% of couples who are attempting to conceive. This can be due to a male
factor in 50% of the cases. Evaluating and correcting any contributing male factor simultaneously with the
female evaluation can expedite the process of a successful pregnancy. With today's advancing technology,
we are able to identify many causes of infertility that have previously been unexplained. There exist many
simple solutions to everyday fertility problems.
Varicoceles
Varicoceles, or varicose veins around the testicles, are the most common cause of male infertility
problems. They can be an isolated problem or contributing to other identifiable causes. Varicoceles are
found in 40% of men presenting to an infertility clinic. These dilated veins are damaged and allow the
testicles to become overheated, reflux metabolites and cause congestion. Varicoceles are also
progressive lesions. If left untreated they can become problematic in future pregnancy attempts.
Varicoceles are effectively treated with microsurgical varicocelectomy. Click on our link to learn more about
varicoceles and their treatment.
Diet
Patients often wonder if there are any dietary modifications that can improve their sperm count and quality
or, more importantly, if any dietary habits could be hindering normal sperm production. There is research
to suggest that certain supplements such as vitamin E, fructose and L-carnitine are beneficial to sperm
when taken at recommended doses because of their anti-oxidant and nutritional properties. Other less
studied ingredients include zinc, arginine, and vitamins C and B-12. These nutrients are the basis for
many of the commercially available fertility blend supplements. However, it isn't necessary to over-pay for
these commercial supplements when equivalent generic forms are available at virtually every health store.
Soy based milk and products are becoming increasingly popular, especially for lactose-intolerant
individuals. They provide good nutrition and are considered healthy alternatives for milk products.
However, all soy-based products contain weak estrogens (genistein and daidzein) which can negatively
impact sperm quality. Recent human and animal studies have shown that when these substances are
given at doses equivalent to human consumption they will cause the sperm to prematurely undergo
capacitation and the acrosome reaction.(Fraser, Human Reproduction, 2006) This will essentially make
sperm unable to fertilize an egg. Avoiding soy based products while trying to conceive is recommended.
Obstruction
Obstruction of the reproductive tract is the second most common cause of male infertility. This can be in
the form of acquired (i.e. vasectomy, scarring after infection) or congenital (i.e. absence of the vas deferens,
cysts) problems. Obstruction can occur in any portion of the reproductive tract from the epididymis and vas
deferens to the ejaculatory duct. Appropriate evaluation and testing is important in identifying the location of
the obstruction, the cause of the obstruction and planning for reconstructive surgery.
Hormones
Hormones are an integral part of any infertility evaluation. Normal hormonal levels are important for normal
sperm production. When abnormal, they can be an indication of other more significant problems.
Correction of any hormonal abnormality is essential for a successful natural pregnancy.
Genetic Causes
Genetic abnormalities are an increasing proportion of problems associated with male infertility. Based on
the level of sperm in the ejaculate, genetic testing might be indicated. We now know that microdeletions of
the Y chromosome, chromosome abnormalities and cystic fibrosis mutations are all significant
contributing factors to male infertility. Genetic testing is only indicated when the findings of a clinical exam
suggest that there is likely a problem. If a genetic abnormality is identified, your physician will discuss the
treatment options and whether advanced genetic counseling is necessary.
Infection/Inflammation
Previous infection such as epididymitis, prostatitis or a sexually transmitted disease can be a contributing
factor to male factor infertility. Patients can develop scarring and obstruction leading to very low sperm
counts or sperm with low motility. This can be diagnosed and treated if identified. Additionally, unwanted
inflammation in the reproductive tract can hinder normal sperm function and fertilization. Additional testing
may be required to diagnose this problem. It can be the result of previous infection or increased sperm
turnover secondary to another problem such as varicocele. Medical therapy exists for treating infection and
inflammation. Other therapies may be indicated to treat the underlying problem leading to
infection/inflammation.
Ejaculatory Dysfunction
Even when sperm production is normal, there can be a functional problem with getting the sperm where it
needs to be at the time your wife is ovulating. This can be due to Retrograde Ejaculation or Anejaculation
which can manifest itself as a normal or low semen volume. We commonly see this condition in patients
with Diabetes Mellitus, Spinal Cord Injury, Neurologic Diseases, Previous Abdominal/Pelvic Surgery or
Surgery for Testicular Cancer. This condition is easily treated with medication or a simple procedure.
Recurrent Pregnancy Loss (Miscarriage)
Recurrent miscarriages can be the result of sperm chromosome abnormalities which prior to today went
undiagnosed. We now know that most cases of miscarriage are due to abnormalities of a small set of
chromosomes (13, 18, 21, X, Y). These chromosomal abnormalities of sperm can now be evaluated to
give the couple a better understanding of the reason for the miscarriage and treatment options can be
discussed to avoid future miscarriages.
Services Provided
Male Fertility Evaluation
Referral Services for Female Evaluation
Hormonal Testing
Semen Analysis
* Volume, concentration, motility, round cells, clumping, viscosity
Advanced Semen Testing
* Strict Morphology (Kruger)
* Sperm DNA Decondensation Test (SDD)
* Sperm DNA Fragmentation Assay (SDFA)
* Anti-Sperm Antibodies
* Sperm Penetration Assay
Genetic Testing and Counseling
* Karyotype (Chromosome Analysis)
* Y chromosome microdeletions
* Cystic fibrosis gene mutation testing
Sperm Retrieval
* PESA (Percutaneous epididymal sperm aspiration)
* TESE (Testicular sperm extraction)
* MESA (Microsurgical epididymal sperm aspiration)
* Microdissection TESE
* Testicular Mapping
* Testicular Biopsy
Reconstructive Surgery
* Varicocelectomy
* Vasovasostomy
* Epididymovasostomy
* Vasography
* Transurethral resection of the ejaculatory duct (TURED)
Sperm Washing for Intra-Uterine Insemination (by referring physician request)
* Regular Wash
* Soft Wash
* Isolate Wash
* Chymotrypsin Wash
factor in 50% of the cases. Evaluating and correcting any contributing male factor simultaneously with the
female evaluation can expedite the process of a successful pregnancy. With today's advancing technology,
we are able to identify many causes of infertility that have previously been unexplained. There exist many
simple solutions to everyday fertility problems.
Varicoceles
Varicoceles, or varicose veins around the testicles, are the most common cause of male infertility
problems. They can be an isolated problem or contributing to other identifiable causes. Varicoceles are
found in 40% of men presenting to an infertility clinic. These dilated veins are damaged and allow the
testicles to become overheated, reflux metabolites and cause congestion. Varicoceles are also
progressive lesions. If left untreated they can become problematic in future pregnancy attempts.
Varicoceles are effectively treated with microsurgical varicocelectomy. Click on our link to learn more about
varicoceles and their treatment.
Diet
Patients often wonder if there are any dietary modifications that can improve their sperm count and quality
or, more importantly, if any dietary habits could be hindering normal sperm production. There is research
to suggest that certain supplements such as vitamin E, fructose and L-carnitine are beneficial to sperm
when taken at recommended doses because of their anti-oxidant and nutritional properties. Other less
studied ingredients include zinc, arginine, and vitamins C and B-12. These nutrients are the basis for
many of the commercially available fertility blend supplements. However, it isn't necessary to over-pay for
these commercial supplements when equivalent generic forms are available at virtually every health store.
Soy based milk and products are becoming increasingly popular, especially for lactose-intolerant
individuals. They provide good nutrition and are considered healthy alternatives for milk products.
However, all soy-based products contain weak estrogens (genistein and daidzein) which can negatively
impact sperm quality. Recent human and animal studies have shown that when these substances are
given at doses equivalent to human consumption they will cause the sperm to prematurely undergo
capacitation and the acrosome reaction.(Fraser, Human Reproduction, 2006) This will essentially make
sperm unable to fertilize an egg. Avoiding soy based products while trying to conceive is recommended.
Obstruction
Obstruction of the reproductive tract is the second most common cause of male infertility. This can be in
the form of acquired (i.e. vasectomy, scarring after infection) or congenital (i.e. absence of the vas deferens,
cysts) problems. Obstruction can occur in any portion of the reproductive tract from the epididymis and vas
deferens to the ejaculatory duct. Appropriate evaluation and testing is important in identifying the location of
the obstruction, the cause of the obstruction and planning for reconstructive surgery.
Hormones
Hormones are an integral part of any infertility evaluation. Normal hormonal levels are important for normal
sperm production. When abnormal, they can be an indication of other more significant problems.
Correction of any hormonal abnormality is essential for a successful natural pregnancy.
Genetic Causes
Genetic abnormalities are an increasing proportion of problems associated with male infertility. Based on
the level of sperm in the ejaculate, genetic testing might be indicated. We now know that microdeletions of
the Y chromosome, chromosome abnormalities and cystic fibrosis mutations are all significant
contributing factors to male infertility. Genetic testing is only indicated when the findings of a clinical exam
suggest that there is likely a problem. If a genetic abnormality is identified, your physician will discuss the
treatment options and whether advanced genetic counseling is necessary.
Infection/Inflammation
Previous infection such as epididymitis, prostatitis or a sexually transmitted disease can be a contributing
factor to male factor infertility. Patients can develop scarring and obstruction leading to very low sperm
counts or sperm with low motility. This can be diagnosed and treated if identified. Additionally, unwanted
inflammation in the reproductive tract can hinder normal sperm function and fertilization. Additional testing
may be required to diagnose this problem. It can be the result of previous infection or increased sperm
turnover secondary to another problem such as varicocele. Medical therapy exists for treating infection and
inflammation. Other therapies may be indicated to treat the underlying problem leading to
infection/inflammation.
Ejaculatory Dysfunction
Even when sperm production is normal, there can be a functional problem with getting the sperm where it
needs to be at the time your wife is ovulating. This can be due to Retrograde Ejaculation or Anejaculation
which can manifest itself as a normal or low semen volume. We commonly see this condition in patients
with Diabetes Mellitus, Spinal Cord Injury, Neurologic Diseases, Previous Abdominal/Pelvic Surgery or
Surgery for Testicular Cancer. This condition is easily treated with medication or a simple procedure.
Recurrent Pregnancy Loss (Miscarriage)
Recurrent miscarriages can be the result of sperm chromosome abnormalities which prior to today went
undiagnosed. We now know that most cases of miscarriage are due to abnormalities of a small set of
chromosomes (13, 18, 21, X, Y). These chromosomal abnormalities of sperm can now be evaluated to
give the couple a better understanding of the reason for the miscarriage and treatment options can be
discussed to avoid future miscarriages.
Services Provided
Male Fertility Evaluation
Referral Services for Female Evaluation
- Nova IVF
- Stanford University IVF
- Palo Alto Medical Foundqation (PAMF) IVF
- Fertility Physicians of Northern California (FPNC)
Hormonal Testing
Semen Analysis
* Volume, concentration, motility, round cells, clumping, viscosity
Advanced Semen Testing
* Strict Morphology (Kruger)
* Sperm DNA Decondensation Test (SDD)
* Sperm DNA Fragmentation Assay (SDFA)
* Anti-Sperm Antibodies
* Sperm Penetration Assay
Genetic Testing and Counseling
* Karyotype (Chromosome Analysis)
* Y chromosome microdeletions
* Cystic fibrosis gene mutation testing
Sperm Retrieval
* PESA (Percutaneous epididymal sperm aspiration)
* TESE (Testicular sperm extraction)
* MESA (Microsurgical epididymal sperm aspiration)
* Microdissection TESE
* Testicular Mapping
* Testicular Biopsy
Reconstructive Surgery
* Varicocelectomy
* Vasovasostomy
* Epididymovasostomy
* Vasography
* Transurethral resection of the ejaculatory duct (TURED)
Sperm Washing for Intra-Uterine Insemination (by referring physician request)
* Regular Wash
* Soft Wash
* Isolate Wash
* Chymotrypsin Wash
Could you tell me what sperm is made of?
Sperm, like all other cells in the body, are made of protein, carbohydrates, lipids and contain genetic
information in the form of DNA. What makes sperm unique is the fact that they are made up of only half of
the genetic material (DNA) that all other cells are composed of. This half DNA combines with the maternal
half of DNA when the sperm fertilizes the egg, recreating a complete set of DNA. This is what makes the
child a "mix" of both parents.
How long does sperm live in the man's body?
The normal cycle of sperm formation and maturation takes approximately 3 1/2 months. Approximately five
days after the completion of maturation, sperm has a gradual decay in survival. This is one of the reasons
why we recommend couples not to abstain for more than 5 days from intercourse when they are
undergoing male fertility evaluation. Optimal sperm quality is seen in ejaculates with abstinence periods
between 2-5 days.
What is the average number of sperms in the average ejaculate?
The average sperm concentration in the ejaculate of fertility proven men is 60-120 million sperm per ml.
However, the WHO (World Health Organization) has established a cutoff of 20 million sperm per ml as a
normal value below which we begin to see problems with fertility.
How long does it take the sperm to get to the egg?
Sperm have been shown to appear in the fallopian tubes as early 10 minutes after deposition into the
vagina (i.e. sexual intercourse). They reach a steady state concentration in the fallopian tubes in 35
minutes. The sperm fertilizes the egg in the fallopian tubes.
Could you tell me how the sperm knows how and where to swim? Are there any female
processes that help the sperm do that?
The sperm and egg send molecular signals to each other that are referred to as "chemotactic" factors.
This is the same way that many cells in the body communicate with one another. This signaling
mechanism is complex and researchers are not certain which are the exact messengers in this process.
Is there a way I can check my fertility status or sperm count at home?
There are commercially available male fertility tests. Unfortunately, these tests are unreliable and only
evaluate the simplest aspects of a man's sperm count. A normal result does not rule out a male factor for
infertility. A formal semen analysis is a much more complex test. Your physician may order more specific
semen tests based on your evaluation. There are many other factors that can be found to be a contributing
factor to a couple's fertility problem even when these "home" tests are normal.
I have recently heard that experts now know that successful sperm use their tails to
make one final jump into the egg -- and new research is revealing just how it happens.
Can you explain that?
The final step in the sperm's long journey after it encounters the egg is to fertilize the egg. The sperm
penetrates the tough outer layer of the egg called the zona pellucida. This requires the sperm to undergo a
process called the acrosome reaction where enzymes help to breakdown some of this outer layer. The
sperms whip-like tail motion helps the sperm with the final penetration through this layer.
What kind of tips can you give on how a man can help boost sperm count?
The best general guidelines for any couple wanting to conceive is that anything that is good for their
general health is good for their sperm. Conversely, anything harmful to their general health is bad for
sperm. It is important to know that sperm represent some of the most sensitive cells in the body with
respect to their ability to tolerate extreme conditions (i.e. heat, toxins, drugs). A healthy diet, replete with
antioxidants with avoidance of situations which place the testicles in extreme heat is considered good
general advice.
Sperm, like all other cells in the body, are made of protein, carbohydrates, lipids and contain genetic
information in the form of DNA. What makes sperm unique is the fact that they are made up of only half of
the genetic material (DNA) that all other cells are composed of. This half DNA combines with the maternal
half of DNA when the sperm fertilizes the egg, recreating a complete set of DNA. This is what makes the
child a "mix" of both parents.
How long does sperm live in the man's body?
The normal cycle of sperm formation and maturation takes approximately 3 1/2 months. Approximately five
days after the completion of maturation, sperm has a gradual decay in survival. This is one of the reasons
why we recommend couples not to abstain for more than 5 days from intercourse when they are
undergoing male fertility evaluation. Optimal sperm quality is seen in ejaculates with abstinence periods
between 2-5 days.
What is the average number of sperms in the average ejaculate?
The average sperm concentration in the ejaculate of fertility proven men is 60-120 million sperm per ml.
However, the WHO (World Health Organization) has established a cutoff of 20 million sperm per ml as a
normal value below which we begin to see problems with fertility.
How long does it take the sperm to get to the egg?
Sperm have been shown to appear in the fallopian tubes as early 10 minutes after deposition into the
vagina (i.e. sexual intercourse). They reach a steady state concentration in the fallopian tubes in 35
minutes. The sperm fertilizes the egg in the fallopian tubes.
Could you tell me how the sperm knows how and where to swim? Are there any female
processes that help the sperm do that?
The sperm and egg send molecular signals to each other that are referred to as "chemotactic" factors.
This is the same way that many cells in the body communicate with one another. This signaling
mechanism is complex and researchers are not certain which are the exact messengers in this process.
Is there a way I can check my fertility status or sperm count at home?
There are commercially available male fertility tests. Unfortunately, these tests are unreliable and only
evaluate the simplest aspects of a man's sperm count. A normal result does not rule out a male factor for
infertility. A formal semen analysis is a much more complex test. Your physician may order more specific
semen tests based on your evaluation. There are many other factors that can be found to be a contributing
factor to a couple's fertility problem even when these "home" tests are normal.
I have recently heard that experts now know that successful sperm use their tails to
make one final jump into the egg -- and new research is revealing just how it happens.
Can you explain that?
The final step in the sperm's long journey after it encounters the egg is to fertilize the egg. The sperm
penetrates the tough outer layer of the egg called the zona pellucida. This requires the sperm to undergo a
process called the acrosome reaction where enzymes help to breakdown some of this outer layer. The
sperms whip-like tail motion helps the sperm with the final penetration through this layer.
What kind of tips can you give on how a man can help boost sperm count?
The best general guidelines for any couple wanting to conceive is that anything that is good for their
general health is good for their sperm. Conversely, anything harmful to their general health is bad for
sperm. It is important to know that sperm represent some of the most sensitive cells in the body with
respect to their ability to tolerate extreme conditions (i.e. heat, toxins, drugs). A healthy diet, replete with
antioxidants with avoidance of situations which place the testicles in extreme heat is considered good
general advice.
Frequently Asked Questions