Dr. Bastuba explains what a woman can do if she thinks her partner has a fertility problem and describes the causes of male infertility.
Okay, if we’re concerned, now it used to be that the definition of fertility for most fertility experts was that when the couple has tried for one year and not been able to initiate a pregnancy then and only then should you start looking into fertility issues.
My current recommendation is that any time is the appropriate time for a couple to look into things. Certainly if the female is in her late 30s or early 40s waiting a year would not make much sense, but for any couple, even if they are in their 20s, if they want answers then that is the appropriate time to look into things.
The way I typically see a patient is when the male has had a semen analysis. Typically, his female partner has already been to the gynecologist. She has asked for a basic evaluation, and as part of that evaluation typically a good gynecologist would suggest that the male should have a semen analysis.
This is a basic study. The first thing we find out is if there’s any sperm in the ejaculate. If there’s no sperm then we absolutely have problems, but we also want to look at other things. The pH of the specimen can give us many clues, the concentration - how many sperms are in the ejaculate per unit volume, typically that is a milliliter, a small amount, and in that we’d like to see 20 to 200 million sperms per milliliter – sounds like a lot, but it takes a lot to be able to initiate a pregnancy.
We look at the shape of the sperm, also known as the morphology. We look at the activity of the sperm known as the forward progression and these things can give us a lot of information about potential fertility in the male.
Following that, as long as we have sperm present, the important things about workup would be the history of the male. Some of the things that we have been discussing in terms of their habits, high alcohol intake, smoking, use of Jacuzzis, these kind of things can potentially affect sperm production and fertility in the male.
Other things of importance in the male history could be surgeries; maybe as a toddler a hernia repair was done. Sometimes this can lead to a blockage of the sperm track. Various anatomic or parts of our body that were not quite perfect from time of birth; one thing known as cryptorchidism, a testicle that started up as all do, inside the belly but never descended down into the scrotum. That can be an important aspect in terms of male fertility.
So from a history standpoint there are many things we’d like to know. That then oftentimes, the history then oftentimes leads to some basic laboratory testing. For instance, just like a female varies throughout the month; she ovulates, she menstruates, her body is changing. But for the male, our sperm counts can go up and down and so, I feel it’s very important not to hang everything on a single semen analysis.
Where the semen analysis is done is important. Many laboratories such as the large laboratories there may be with thousand or two thousand different tests. The semen analysis is a very specific test and really is best done at a fertility lab where that’s one of the only things they do.
It takes a lot of time to do them and it’s very easy to make mistakes on them. So I have had many patients I have seen through the years who come to me saying, “I have no sperm in my ejaculate doc. I guess I have, you know, I have been waiting five or ten years thinking that there was no hope. Is there any hope?”
We do what I would call a real semen analysis. Sometimes we spin it down at high velocity in a centrifuge and we’ll find sperm there and it instantly changes that couple’s life. They realize that they actually had lost a fair amount of time. So again, hope – don’t give up until you have answers that you feel completely comfortable with.
The other things that are oftentimes required are hormone testing. Just as a female would have basic hormone testing that’s oftentimes important in the male. We look at testosterone. We look at a hormone known as FSH or follicle-stimulating hormone – same one that we look at in females. We also actually look at the testosterone to estradiol ratio.
Again, the female has those same two products but it’s a vastly different ratio between the two, and in the male, if that’s off, oftentimes a pill a day can have a dramatic impact on testosterone levels and also on sperm production.
About Dr. Martin D. Bastuba:
As San Diego's leading subspecialist in male fertility and male and female sexual dysfunction issues, Dr. Martin Bastuba gives hope to couples who have been unable to conceive, and to men and women who are experiencing the anxieties and frustration of sexual dysfunction. He offers complete diagnosis, treatment, prevention techniques and education for his patients.