Up to 50% of infertile couples are impacted by male infertility. The goal of treatment is to optimize the numbers and quality of sperm in an effort to increase a couple’s chances of conceiving without assistance or with less invasive methods when pursuing medically-assisted fertility treatments. For those couples who cannot conceive on their own, intrauterine insemination (IUI) or in vitro fertilization (IVF) offer effective treatment options.
IUI is a treatment that takes things “one step beyond” the bedroom. Timed with the female partner’s ovulatory cycle, the male partner provides a semen sample that is “washed” by the fertility laboratory. This washing process results in a concentrated sample of the best sperm that is instilled through the woman’s cervix into her uterus. This approach optimizes timing relative to ovulation and location of the best sperm to the egg. The number of moving sperm in the washed sample (“total motile sperm count”) is highly associated with IUI success. There are also some studies that have linked the percentage of sperm with normal shapes (sperm morphology) and the percentage of sperm with healthy DNA to better IUI outcomes. Interventions that can improve sperm count and quality may yield better IUI outcomes and reduce the costs, stresses and medication exposures associated with IVF.
When IUI doesn’t work, IVF may be employed. During IVF the female partner receives medication to promote egg development and then undergoes a transvaginal procedure to have eggs retrieved from her ovaries. The fertilization process takes place in Petri dishes in the embryology lab. Sometimes this involves placing a droplet of concentrated sperm onto each egg, but for more severe cases of male factor infertility a process referred to as intracytoplasmic sperm injection (ICSI) may be used. With ICSI, one sperm is injected into each egg in an effort to optimize fertilization. Fertility doctors previously thought that sperm quality was not an important driver of IVF outcomes. In fact, IVF with ICSI started to be viewed as a treatment for male factor infertility. Emerging data has made it increasingly clear, however, that sperm quality can and does affect reproductive outcomes in many cases. Optimization of sperm quality before IVF can meaningfully improve success rates.
