Infertility: not just a female condition

Infertility is not just female
Body: 

By Landon Trost, MD

Infertility is a Couple Issue

Although infertility is commonly felt to be a female condition, a male factor often plays a significant role. Overall it is estimated that infertility affects 8 to 14% of couples. Among these couples Male infertility contributes in 36 to 75% of cases.1-5 Certain risk factors place a male at higher risk of having infertility including any abnormalities or issues with the testicles themselves, prior treatment for cancer, hormonal disorders, prior scrotal surgery, or even infections such a sexually transmitted diseases.

Male Infertility May Indicate Other Health Issues

In addition to the fertility concerns, it is important to identify males who are infertile for several health-related reasons. Male infertility maybe the first indicator of an underlying genetic syndrome such as Kallman, Klinefelter, or cystic fibrosis.  Also, men with male infertility are at a higher risk of developing testicular cancer with rates ranging from 0.3 to 0.9%.6-8 They may also be at higher risk for developing colorectal cancer, melanoma, or even prostate cancer.9, 10 

Goals of Male Fertility Evaluation

There are several important objectives that we use when treating infertile males.  These are reported in the AUA Best Practice Statement on the evaluation of the infertile male:11, 12

1. Recognize and treat reversible conditions

2. Categorize disorders potentially amenable to assisted reproductive techniques

3. Identify syndromes and conditions which may be detrimental to the patient's

4. Distinguish genetic abnormalities which can be transmitted to or affect the health of offspring.

Many Male Infertility Conditions are Treatable

As with any disease, there are a percentage of patients who will not benefit from treatment. However with male infertility many conditions are treatable or can be reversed.  Surgical options exist for select cases including varicocelectomy, vasectomy reversal, epididymovasal reconstructions, or other procedures to relieve an obstructed ejaculatory system.  Treatment of these conditions often results in dramatic changes in overall sperm counts and paternity.  Medications can also be used to improve the chances for spontaneous pregnancy in many cases.

Male Fertility Evaluation

A male fertility evaluation typically begins with a thorough history and examination. Many contribute factors to infertility can be identified in this way. Abnormal physical findings which can contribute to infertility include small testicles, undescended or absent testicles, the presence of a varicocele, or evidence for prior scrotal trauma, Infection, or surgery.

If not performed previously, obtaining several semen analyses can help to identify clues for the infertility. Additionally blood tests such as FSH, LH, and testosterone are often obtained. In some cases specialized testing such as Y-chromosome microdeletions, cystic fibrosis panels, and karyotype analyses may be performed.  Each of these tests provide additional information and help to determine the optimal strategy for treatment.

Options When Spontaneous Pregnancy is Unlikely

In some cases, spontaneous pregnancy is unlikely to occur regardless of medical or surgical therapies. This often leads to the couple being referred for assisted reproductive techniques such as in vitro fertilization or intracytoplasmic sperm injection.  On the male side and depending on whether or not sperm are present in the ejaculate,  specialized procedures may be required to retrieve sperm directly from the testicle. This can frequently be done using minimally invasive and cost effective techniques.

Remember Your Goals

Infertility can often lead to stress both for the individual as well as the couple. Evaluations, treatments, appointments, pregnancies, miscarriages, finances, and many other factors all contribute to this stress. It is very important in these situations to not lose sight of your underlying goals while maintaining an appropriate balance of optimism and realistic expectations.  Since the health of the couple is just as significant as a successful pregnancy, time spent focusing on each other’s emotional and mental health needs can be beneficial.

Trost Biographic Sketch

Dr. Landon Trost is an assistant professor in urology and head of male infertility and andrology at the Mayo Clinic in Rochester, MN.  He received his undergraduate training at Brigham Young University in Provo, UT, where he graduated Magna Cum Laude and Valedictorian.  He underwent his medical training at Tulane University in New Orleans, LA where he received honors in all classes and was awarded Junior AOA status.  He completed residency training in urology at Mayo Clinic in Rochester, MN and was named as a Mayo Scholar Recipient.  He continued specialty fellowship training in andrology and infertility at Tulane University, University of Florida, and Memorial Sloan-Kettering Cancer Center and was recently awarded the Teacher of the Year 2015 for the Department of Urology. 

His clinical and research interests include male factor infertility, male vasectomy reversal, male sexual function, Peyronie’s disease, and hypogonadism.  He has published over 40 peer-reviewed publications and editorials, 10 book chapters, and was involved in writing the core curriculum for the American Urological Association on the topic of male hypogonadism and male infertility.  Dr. Trost is currently serving as the chair of the Young Investigators Committee for the Sexual Medicine Society of North America, co-chair of the Communications Committee for the International Society of Sexual Medicine, as a Research Committee member for the Sexual Medicine Society of North America, and as a committee member for the 4th International Consultation on Sexual Medicine. 

 

Contact Information:

Appointments – (507) 538-5363
Secretary – (507) 294-4248
Fax – (507) 284-4951
Address – 200 First St SW Rochester, MN 55905

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References:

1.         Thonneau, P. et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Human reproduction 6, 811-6 (1991).

2.         Bablok, L. et al. Patterns of infertility in Poland - multicenter study. Neuro endocrinology letters 32, 799-804 (2012).

3.         Chiamchanya, C. & Su-angkawatin, W. Study of the causes and the results of treatment in infertile couples at Thammasat Hospital between 1999-2004. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 91, 805-12 (2008).

4.         Case, A.M. Infertility evaluation and management. Strategies for family physicians. Canadian family physician Medecin de famille canadien 49, 1465-72 (2003).

5.         Templeton, A., Fraser, C. & Thompson, B. The epidemiology of infertility in Aberdeen. BMJ 301, 148-52 (1990).

6.         Carmignani, L. et al. Detection of testicular ultrasonographic lesions in severe male infertility. The Journal of urology 172, 1045-7 (2004).

7.         Kanto, S. et al. Incidental testicular cancers that subsequently developed in oligozoospermic and azoospermic patients: report of three cases. Fertility and sterility 88, 1374-6 (2007).

8.         Raman, J.D., Nobert, C.F. & Goldstein, M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. The Journal of urology 174, 1819-22; discussion 1822 (2005).

9.         Walsh, T.J. et al. Infertile men may have increased risk for non-germ cell cancers. Data from 51318 infertile couples. J Urol 179, 654 (2008).

10.       Salonia, A. et al. Are infertile men less healthy than fertile men? Results of a prospective case-control survey. European urology 56, 1025-31 (2009).

11.       Jarow, J. et al. The Optimal Evaluation of the Infertile Male: Best Practice Statement Revised (2010).  (2010).

12.       Jarow, J. et al. The Evaluation of the Azoospermic Male: Best Practice Statement Revised (2010).  (2010).

 

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