Some studies have shown that up to 50% of couples experiencing infertility may have a male factor present. Couples with a male factor are among the most common in our practice, and the good news is that there are many treatments available to help these couples have a child.
One of the first steps in any fertility evaluation is a thorough history of the male partner and a detailed semen analysis. Sometimes more specific tests on the structure and function of the sperm will be necessary. Often the man will be evaluated by a urologist to look for anatomical causes for the abnormal sperm parameters. Blood work to evaluate the presence of endocrine disorders or chromosomal abnormalities may also be indicated.
The presence of a male issue does not absolutely mean that this is the only cause of a couple’s inability to conceive or even the main cause. An evaluation of the female partner is also addressed even when a male factor is present.
One of the most commonly utilized treatments for infertility is the procedure referred to as Intrauterine Insemination, or “IUI,” whereby sperm are inserted into the uterine cavity through a thin tube (catheter). Once in the uterus, the sperm still have to navigate the fallopian tube and fertilize the egg. Therefore, the fertilization process occurs in the body in a natural fashion. This is in marked contrast to in vitro fertilization (IVF), a much more complicated process, whereby the eggs are removed from the ovaries and fertilized in the laboratory.
There are a number of indications for IUI. First, the procedure is performed when there is a documented sperm problem and it is felt the sperm cannot reach the egg. This is most successful when there are mild abnormalities of the sperm parameters. The sperm quality is enhanced by the IUI due to the fact that the sperm are processed in the laboratory, washed, concentrated, and placed in a highly specialized culture fluid.
Second, we use IUI when there is an abnormal sperm/cervical mucus interaction and the sperm is unable to penetrate the mucus. This is a very logical and favorable indication for the IUI.
Third, IUI may also benefit couples experiencing male sexual dysfunction with an inability to achieve erection or orgasm.
Finally, protocols include IUI in the case of unexplained infertility.
Stimulated IUI (IUI with fertility drugs) – Many studies have suggested that IUI may be more successful if coupled with ovulation induction using fertility drugs. The fertility drugs often utilized are the oral medications clomiphene (Clomid) and letrazole (Femara) or injectable medications known as gonadotropins. Fertility medications increase the number of eggs produced, possibly increasing the chance that a fertilized egg will implant in the woman’s uterus. Because fertility medications can produce several eggs, careful monitoring of the woman is important to ensure that side effects of the treatment and risks of multiple pregnancy are reduced.
IUI for Retrograde Ejaculation – A somewhat rare occurrence is retrograde ejaculation whereby sperm go backwards into the bladder rather than through the penis during ejaculation. This situation may occur due to previous surgery, diabetes, spinal cord injury, or certain medications. It is possible to retrieve the sperm from the bladder by having the man void after ejaculation, process the sperm, and then perform IUI to achieve pregnancy. This tends to be a very successful treatment for this particular condition.
Freezing Sperm (Cryopreservation) – We have the ability to arrange for the cryopreservation of sperm in the situation where a man may want his sperm frozen for use at a future time. Such cases might include gentlemen undergoing treatment for cancer or other medical conditions that might affect sperm, or prior to a vasectomy. Couples may also elect cryopreservation when the man will not be available when fertility treatment is to occur.
Donor Sperm – The above descriptions refer to the insemination procedure utilizing the husband’s sperm. However, IUI can also be performed using donor sperm obtained from a sperm bank. In these “banks,” the sperm are extensively screened for transmissible disease and frozen for future use. This is indicated when there is a highly significant sperm factor in the husband. It obviously can also be used in women without male partners.
IUI is a relatively easy office procedure and can often provide a non-invasive and closer-to-natural solution to a couple’s infertility. Our program has much experience in these situations and we are here to discuss available options and to answer all questions.