Reproductive Biology and Endocrinology reports that male and female factor infertility are close to equally common: a male partner contributes to the infertility of up to 50 percent of infertile couples. However, a lack of robust data has hampered the development of global health guidelines for male infertility.
While researchers and clinicians are still working to understand the specific causes of male factor infertility, identifying the best treatment options has proven to be difficult. Ultrasound has, however, become an important tool for diagnosing and treating this condition.
Understanding Male Infertility
Although it has a long history of medical study, male factor infertility is often underplayed. Many infertile couples do not realize the need for a separate male factor assessment prior to seeking treatment, and some do not even undergo a basic semen analysis.
While male factor infertility is still poorly understood, its main causes may be classified into three groups: clinical causes, environmental causes and lifestyle causes.
Clinical Causes
Some cases of male infertility can be traced to clinical problems. Swelling of testicular veins, called a varicocele, may alter the testicular temperature, diminish sperm quality or quantity and cause semi-permanent damage. An infection or retrograde ejaculation into the bladder due to prior surgery may also compromise fertility.
An injury or scarcity of spermatozoa (or sperm) in the semen, often mistaken for azoospermia, can make pregnancy challenging. Notably, most cases of actual azoospermia can now be treated by isolating sperm from the epididymis or testicle and injecting them into eggs during in vitro fertilization (IVF), a process called intracytoplasmic sperm injection (ICSI).
Lifestyle and Environmental Causes
Male patients' habits and overall health can also contribute to infertility. Smoking, drug and alcohol abuse, emotional stress, depression and excess weight are all known factors in the etiology of male factor infertility. Overheating the scrotum by frequent use of hot tubs and saunas or wearing tight-fitting clothing may also impair sperm production and cause temporary or permanent damage.
Exposure to industrial chemicals such as heavy metals and pesticides may reduce sperm function, according to Biology and Medicine. Researchers are still identifying all of the chemical pollutants that could potentially impact male reproductive health.
Ultrasound For Male Infertility
According to Current Urology Reports, scrotal and transrectal ultrasound may help illuminate the causes of male factor infertility and aid in further fertility assessment and treatment. Routine semen analysis allows clinicians to more closely examine sperm's relative motility, progression, function, morphology and cell counts per milliliter.
Ultrasound, helps assess the vascular environment: the presence and severity of varicoceles, testicular size and volume and the presence and nature of vas deferens obstruction. It can also detect any masses or malignancy.
Diagnostic and Treatment Tools
Reproductive Biology and Endocrinology found that there are at least 30 million infertile men worldwide. Just as with female infertility, further research is needed to determine the most effective treatments, reduce cultural stigma and remove obstacles to patient care.
Fortunately, assisted reproductive technology (ART) can overcome many forms of male infertility, no matter the cause. At least some sperm can usually be isolated for artificial insemination. Mixed-sex couples awaiting an infertility diagnosis should consult an andrology specialized reproductive urologist to learn about this option.
Ultrasound evaluation is cost-effective, noninvasive and potentially able to uncover underlying pathologies that were missed during a man's regular physical exam. Adding a male partner's ultrasound to a diagnostic regimen allows the physician to assess testicular anatomy and vascularity more accurately, which may help determine successful treatment options.
