Seeking Help for Male Infertility

by Steven J. Hirshberg, MD and Lawrence Grunfeld, MD

Most of us assume that our ability to have children is secure. After all, procreation is a basic human right, is it not? Well for some, this basic right is not so simple.

Infertility can be a painful and confusing experience for couples mentally prepared to have children. Approximately fifteen percent of American couples struggle with infertility, and although neither partner is ever "to blame," the situation can become enormously stressful for individuals and couples alike.

Approximately one-third of infertility cases can be attributed to problems with the sperm. Below, Dr. Steven Hirschberg and Dr. Lawrence Grunfeld discuss diagnosis methods for male factor infertility.

Q: When should a couple begin to think about seeking professional help for infertility?

In general, after one year of unprotected intercourse, we recommend seeing a doctor who deals with infertility regularly. We make it earlier in women who are over the age of thirty-five, especially because once women get to age of forty, the percentage of infertility within the couple itself increases.

Q: Who comes to the first consultation?

We encourage a couple to come together for the first consultation. It doesn't always happen. Sometimes the guys are a little shy, and the woman is representative of the couple. As a gynecologist, I also see single women who are interested in becoming pregnant. But the couples are always encouraged to come together. It's always a team effort.

Q: What type of screening tests do you do to see if there is a male infertility problem?

Quite often, a couple comes to me and the man in the couple says,"I have male infertility. I had a test and my sperm are a little slow or a bit misshapen." The first thing we need to do is look at both individuals in the couple before we entertain that as the primary diagnosis. We completely evaluate the woman to make sure that we're not missing a more profound or serious problem.

When we determine there is a true male infertility diagnosis, as presented by an abnormal semen analysis, the man always deserves a thorough evaluation by urologists competent in the evaluation and treatment of male infertility.

Q: What are you looking for in a semen analysis?

The first thing is the volume or amount of fluid. If there is merely a drop versus the normal amount-which is approximately a half teaspoon-it's going to be much harder for the sperm to find their way up to the egg. Sometimes this can indicate a hormonal problem. Sometimes it indicates a blockage in the system.

Sperm count is also important, but I don't believe it's the most important factor. I think that the percent of the sperm that are moving, and how the sperm are moving, are more important factors.

Q: What is a normal sperm count?

For fertility purposes, we usually like to start with about 20 million. If the sperm are moving relatively well, we can work with that number. I can then do things to try to help bring the count up if that's indicated. If not, there are ways we can manipulate the sperm that are there, since 20 million is a relatively reasonable number.

Q: Can you describe what you're looking for in terms of sperm motility?

We like to see about 50 percent of the sperm moving, and about half of the sperm moving with a straight-forward progression, swimming in a nice straight line, and not just sitting there with their tails wagging, spinning their wheels. How the sperm moves is sometimes as important as how many are moving and how many there are in the first place.

Q: What are you looking for on the female side of things?

We have to know that the plumbing is working, that the uterus and the fallopian tubes are normal. We have to know that there is some ovulation. Often, history is the best test to determine there is ovulation. Quite often, a simple test, although somewhat controversial as to how significant it is, is to see the couple at midcycle; to see them when she is ovulating after intercourse. That test is called a postcoital test.