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, 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.
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
Video: Microsurgical Varicocelectomy performed at El Camino Urology
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 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 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
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.
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 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.
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