Explaining the Male Factor in Infertility скачать в хорошем качестве

Explaining the Male Factor in Infertility

Explaining the male factor in Infertility. In this video, Mark P. Trolice, M.D., board-certified reproductive endocrinology and infertility specialist and founder of Fertility CARE: The IVF Center shares his insights on what men with severe sperm challenges can do to overcome them. “The male factor contributes 40% to infertility," says Dr. Trolice. "40% from the male side and 40% from the female. The way we can evaluate the male provided he doesn’t have any predisposing factors such as prior chemotherapy, undescended testes, major medical problems, medications that can affect infertility or a history of infertility.” What are the things fertility specialists look at to evaluate male infertility? “The sperm analysis is the tried and true method to determine if there is a potential male factor,” says Dr. Trolice. “However, in 2010, the WHO came out with new guidelines to evaluate for sperm analysis, and believe it or not, there are clinics still using a prior edition. We use the 5th edition WHO guidelines from 2010. The parameters that are most important are the density of the sperm, motility, and the morphology (the shape).” “The way they came up with these numbers is that they took fertile men who all had been involved with a pregnancy within one year of trying. So the numbers that you see on the sperm analysis, which are the cutoffs, all those men were able to be successful. And those men represent the 95th percentile. In other words, 5% of them were below these cutoffs, and they were all still involved in a pregnancy.” Dr. Trolice explains that as long as a man has some sperm, there is always a chance for a pregnancy. “It’s never, never until a man has zero sperm.” "Sperm density: 15 million per milliliter or more is considered normal within the 95th percentile but below that doesn’t mean men are infertile,” says Dr. Trolice. “But that could be an area of concern. Motility, how well the sperm are moving. 40% or more is considered normal. And the shapes of the sperm - morphology - only 40% can appear normal, and that is still okay.” “After evaluation, we have the patient see a urologist, and we have a male reproductive specialist on site,” he says. “You want to go to a male specialist because that’s what they do. We’re looking for an anatomical reason (for infertility) with the examination, most commonly a varicocele, which is increasing venous flow around the testes. Like varicose veins in the legs, the increased veins around the testes will reduce sperm numbers and motility because of the increased heat. That’s why the testes are outside the body.” “A man’s hormones are also examined to see if they can be corrected with medication. Then some genetics are looked at like carrier type and cystic fibrosis because there could be a hereditary issue involved.” “After the evaluation, sometimes hormones are necessary like clomiphene citrate, letrozole or even injectable fertility medication,” says Dr. Trolice. “You don’t want the male on testosterone. Testosterone will shut the brain signal to the testes and will result in no sperm in many men, and if you’re on that for too long, it could be irreversible.” “Barring no sperm, intrauterine insemination (IUI) is the first step after an evaluation by the urologist,” says Dr. Trolice. “And we give fertility medication to the woman to increase the number of her eggs. Then we add the sperm to the reproductive tract. We even have the male partner press the plunger when I place the catheter inside the uterus.” Dr. Trolice explains that three cycles of IUI are reasonable before patients start seeing a decrease in pregnancy rates. “IVF is much more aggressive and allows us to maximize fertilization, and in severe cases, we can take a single sperm and inject it directly into the egg,” says Dr. Trolice. “That is called intracytoplasmic sperm injection (ICSI). Each sperm is injected into the egg, and that’s for men with severe sperm abnormalities. ICSI outcomes for pregnancy rates are the same with or without the usage of that.” “In men who have no sperm that’s a condition called obstructive or blocked, or non-obstructive, non-blocked azoospermia, which means no sperm in the ejacular,” Dr. Trolice continues. “We go to the testes to get the sperm. But then you need to do IVF when you get the sperm from the testes because the sperm has to go through the reproductive tract of the man to reach maturation. And if not, we take the sperm from the testes and do IVF or ICSI.” For more visit https://www.myfertilitycare.com/ To learn more about Dr. Trolice visit http://www.myfertilitycare.com/mark-t... To learn more about Fertility CARE fertility services visit https://www.myfertilitycare.com/our-s... To learn more about IVF visit https://www.myfertilitycare.com/ivf/ To learn more about IUI visit https://www.myfertilitycare.com/infer...