Also see Fact
Sheet – Assisted Reproduction (IVF
/ ICSI)
and Male
infertility
IUI for poor morphology
Environment and unexplained infertility
Kallman’s Syndrome
Failure of fertilization with ICSI
Severe oligospermia, Wife age 42
High viscosity of semen
Ways to raise sperm count
Low Morphology
Can there be too few sperm?
Pregnancy with low sperm counts
Low sperm counts and abortion
Question: My husband has a low morphology of 16%. Will there
be any successful pregnancies with IUI?
Comment: It depends on how the morphology was scored. In some
systems (strict criteria) this is a normal reading. If using
the World Heath Organization standards, this is on the low
side and may be associated with infertility. It does not mean
sterility and the chance of pregnancy should be relatively
good. IUI can sometimes be helpful. The majority of pregnancies
are achieved in the first 3 tries. sst
Question: I'm looking for some help.
My husband and I have been suffering from infertility for
over five years now. We have done all testing available to
us, and no reason for our infertility has been found. I have
gone as far as three rounds of IVF, with no success. I have
transfer red up to 5 embryos, all of grade A quality. I'm
desperately looking for an answer. I was hoping that someone
would have some information on the effects of diesel fumes
on a man's reproductive system. My husband works for a big
city Police Department. He is in a special unit called ECU.
They work out of a house, which is set up exactly like their
living quarters are, directly above the garage in which their
diesel trucks are housed. But unlike the fire department,
there is NO proper ventilation system to keep the diesel fumes
out of the living quarters. My husband has told me it sometimes
gets so bad that they choke on the fumes. Plus, there is a
black film buildup on the surfaces throughout the whole office.
They have had the Health Department in to check and they said
it is a health hazard but nothing has been done about it.
(I'm working on getting that information.) The reason I am
looking into this is because there is an abnormally high amount
of men in this unit having infertility problems. More then
half the couples trying are having problems with primary or
secondary infertility. Some men fathered a child before coming
into ESU. There has also been a high amount of miscarriages,
half being ectopic, and myself included. Also some of the
men, after years of infertility, within months of leaving
ESU, their wife becomes pregnant with no medical assistance.
My girlfriend who is also having problems just told me that
her husband’s urologist told him that the diesel could
add to or cause low sperm counts. He was, at the time, a truck
driver. If anyone has any information that can help me, I
would love to hear it. Plus, if there is testing that can
be done to see if the diesel fumes are causing any abnormality
in my husband’s system. I'm trying to build up data
to force the PD to do something about this problem. Even if
there is no connection between the two, this is an unhealthy
environment in which to work.
Comment: Unfortunately we know very little about environmental
toxins and low sperm counts. For that matter, we know little
about the environment and reproduction in general. Certainly,
a good theoretical case could be made for alteration in sperm
function and altered sperm function after exposure to petroleum
by-products. The difficulty is in proving your point. Over
the last several years there has been increasing evidence
that caffeine and nicotine significantly reduces IVF success.
A complicating factor is that your husband may be in a job
where there is a considerable amount of use of these drugs.
In summary, I cannot say yes about the diesel fumes, but I
would never say no. The trouble is and will continue to be,
trying to get someone to listen. It would seem that the cause
of your infertility is tubal, given your ectopic pregnancy.
Here is where you must rely on your fertility specialist.
If the tubes are swollen, a hydrosalpinx, your success may
be lessened. It also may be that your number hasn't come up
yet. Make sure you are in a reputable program with clearly
stated success rates. Make sure your specialist is listening
and talking with you.
Question: I am 32 and, was diagnosed
with Kallman's when in my early teens. My wife and I want
to conceive and have started talking with my endocrinologist
about starting hCG/gonadotropin treatments. We would be interested
in more information on both Kallman's and the treatment logistics.
Comments: Kallman's is a particularly interesting congenital
disorder where the nerve cells that produce the hormone GnRH
(gonadotropin releasing hormone) did not fully develop. These
are very close to the nerve cells for smell. The diminished
production of GnRH results in little production of gonadotropin
and therefore minimal stimulation of the testes. The final
result is that while sperm are there, development is suppressed
and testosterone production is reduced. Treatment including
the use of donor sperm is certainly a cost effective alternative.
Other therapies include induction with gonadotropin and GnRH
pump therapy. Therapy may be relatively long, hard, and expensive,
but the prognosis is good.
Question: What are the possible
reasons for fertilization NOT to occur with ICSI?
Comment: Some would say that fertilization always occurs with
ICSI, but then there can be failure of union of the male and
female genetic material and/or further development does not
always occur. Failure of ICSI can be related to either male
(sperm), or female problems (egg). Sometimes this can be predicted
by why the ICSI procedure is being performed, for example
severe male factor with an otherwise healthy ovulatory female.
Maternal age can also be a significant factor. Sometimes it
is not a male problem at all and the true diagnosis of the
fertility problem: an egg issue is discovered. The best information
comes form a frank discussion with the fertility specialist
and perhaps the embryologist at the center where the procedure
was performed. Sometimes the answer still remains "I
don't know". sst
Question: I have either no sperm
or sometimes very poor sperm in my specimen analysis. What
are my chances of success with ICSI? I am 44 years old and
my wife is 42.
Comment: The first question is why is there an alteration
in sperm number. Is it due to obstruction of the duct system,
or is there a very low number of sperm in the testes? A physical
exam showing smaller testes and an elevated level of follicle
stimulating hormone (FSH) in the blood, indicate that it is
a sperm production problem. In this case, success with any
type of therapy short of donor insemination may have a poor
success rate. If there is a simple obstruction problem, this
may be bypassed by direct aspiration of sperm form the testis
or epididymis. The epididymis is the collection system between
the testis and sperm duct. There is a significant difference
in "no" and "low" sperm counts. If there
is no sperm, only the technique of sperm aspiration is available.
Low sperm counts may be a suitable indication for sperm injection
(ICSI), or possibly even conventional IVF. ICSI rates are
comparable to standard IVF rates and depend on the fertility
of the female partner. At age 42, success rates of IVF with
a normal sperm sample are 5-10% per attempt -- less than half
that at of women under age 40. Perhaps, equally worrisome
is the age of your wife. An FSH level should be obtained on
day 2-3 of her menstrual cycle. If this level is above 20,
the chances of pregnancy, even with normal sperm counts are
very low. With FSH levels of 10-20, the chances of pregnancy
are significantly reduced. Regardless, at age 42 alone, she
has passed the age at which must women will become pregnant.
If your wife were younger, sperm donation might be an alternative.
If your sperm count was higher, egg donation might be an alternative.
Together, your fertility is seriously compromised despite
all of our new technology. Probably a thorough evaluation
and frank discussion with a fertility specialist is the best
advice I can offer. sst
Question: If a man has an abnormal
viscosity count when semen analysis is performed, can it be
treated and how? How does it affect fertility?
Comment: It would seem logical that increased viscosity would
decrease fertility. However, there I do not know of any studies
that substantiate this finding. A good medical history is
important there may be unsuspected causes that be eliminated
that would improve quality of the semen. It seems more important
that the standard parameters studied (number, motility, and
morphology) are most important. If viscosity is a problem,
fertility may be increased by well-timed inseminations after
sperm washing (IUI). No more than 3 inseminations are generally
recommended before other causes of infertility are excluded.
A logical question would be if use of Guafenesin (active ingredient
of Robitussin) would help. Guafenesin has been suggested to
improve cervical mucus. R There is no scientific evidence
of its effectiveness for this and I would not hold out hope
for semen either, but you give it a try. sst
Question: How can you raise a low sperm count naturally?
Comment: Probably - Less stress; less smoking, less heat;
less alcohol; less prescription drug use; good diet and moderate
exercise; possibly vitamin C and zinc supplements. sst
Question: My husband has a low morphology
of 16%. Will there be any successful pregnancies with IUI?
Comment: It depends on how the morphology was scored. In some
systems (strict criteria) this is a normal reading. If using
the World Heath Organization standards, this is on the low
side and may be associated with infertility. It does not mean
sterility and the chance of pregnancy should be relatively
good. IUI can sometimes be helpful. The majority of pregnancies
are achieved in the first 3 tries. sst
Question: What is the low-end threshold for a sperm count
to perform IVF? What is the typical range of a "low"
sperm count for IVF? What are the associated pregnancy rates?
Comment: No longer is there a low end for sperm counts when
considering assisted reproduction. Obviously we want to have
a sperm for each egg, but pregnancies have been achieved with
counts less than 10 sperm. With reduced counts, sperm injection
(ICSI) should be considered. Most centers are relatively liberal
and perform ICSI is most if not all cases of male infertility.
The bad news is hat you may require IVF/ICSI, the good news
is that it works very well and most cases of male infertility
can be treated. Each ART center should supply you with their
center pregnancy rates and be able to evaluate you in the
context of these rates. sst
Question: My husband has a very
low sperm count. Luckily, we were able to conceive naturally
last winter. Do you have any suggestions to increase our chances
of this happening again in the future? This pregnancy took
6 years to achieve even with two artificial insemination attempts.
Comment: This is not as rare as you might think. I have been
surprised by healthy pregnancies in couples very the sperm
counts were judged to be near sterility. I might suggest cycle
tracking with basal body temperature (BBT) and an ovulation
prediction kit (OPK). Recent research has shown that properly
timed intrauterine insemination (IUI) can also be of value.
Your chances of pregnancy after assisted reproduction-- in
vitro fertilization (IVF) with sperm injection (ICSI) may
be excellent. sst
Question: Will low sperm counts
increase chances of abortion or birth defects?
Comment: There is a genetic cause for severely low sperm count
in about 10% of cases. While this may be passed on to male
offspring, there does not seem to be other risks. Carriers
of the cystic fibrosis gene also share an association with
male infertility, Most sperm defects are severe enough not
to allow fertilization. Unhealthy sperm are usually blocked
at the egg surface . Most genetic abnormalities that lead
to pregnancy loss are of egg origin. sst
Also see Fact Sheet –
Assisted Reproduction (IVF
/ ICSI)
and Male
infertility
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