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What To Expect in the Evaluation of Male Infertility
Reproductive Endocrinology and Infertility Specialist, Dr. Alan Martinez, discusses the evaluation of male infertility and what to expect.
Featured Speaker:
After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Transcription:
Melanie Cole (Host): Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I’m Melanie Cole and today, we’re discussing what to expect in the evaluation of male infertility. Joining me is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, always a pleasure to have you on. We don’t typically talk about male infertility with you so, tell us a little bit about it. How prevalent it is and what are some of the most common causes?
Alan Martinez, MD (Guest): As far as male infertility, it is one of the three overall categories that we check when we evaluate and undergo an infertility evaluation. And so, up to one third of cases, you can have of couples that are having issues with conceiving can be due to male factor infertility. So, it is very prevalent, and it is one of the basic tenets of our tests along with checking for the female structurally and then the reproductive hormones as far as the ovaries for the female. So, what usually happens is the tests that are done are two-fold. One, there is something called a semen analysis of where we look at the overall function of the sperm and then usually in addition to that, there may be bloodwork to look at the hormones, to look at the testosterone levels, to look at the profile of the male patient in relation to the sperm function.
Host: Can we bust up a few myths Dr. Martinez, because people have heard over the years various reasons. And I’d like for you to go over some of these, what might increase a man’s risk whether it’s lifestyle. Does tight underwear have a play in this? Does extended bike riding, cigarette smoking, alcohol, stress? Can you clear up a few of these for us?
Dr. Martinez: Absolutely. So, we know that some of the toxins or chemicals that a person can exposed themselves to specifically smoking, as far as other drug use, marijuana use can change the function of the sperm. All of these can have an effect on decreasing the overall sperm function. The extremes of temperatures saying like a patient uses saunas multiple days out of the week, very hot exposure to the testicles and overall temperature changes can lead to lower sperm function. Chemicals, job related chemicals; say a person is a construction worker, he like is involved in working with strong chemicals on the jobsite. That can potentially affect the sperm function. So, those are the environmental and chemical things that may lead to some subfertility as far as from the female perspective.
With regard to tight underwear, and or bicycle use; that overall does not statistically have an effect on the sperm function unless there is extended, extended exposure to maybe compression of the nerves through bicycling but underwear itself, is not going to effect the overall sperm function. It would have to be a very high level use of compression through cycling or other sports that would ultimately lead to decreased sperm function. Now much of that can bounce back with decreased activity and it can recover nicely in the male.
Host: Well thank you for clearing up some of those for us today. So, what can a man expect as he and his partner come in to get evaluated for their fertility issues? When you say that you are then going to do a semen analysis; tell us what that involves, and should the couple abstain from sex before the semen analysis? Tell us what an evaluation is like for the couple.
Dr. Martinez: Much like the female, there is an extensive history and a medical questioning to see if there is any of the risk factors like we talked about before, any issues with puberty, any attempts at pregnancy in the past, any prior miscarriages, live births, any changes in overall health and exposure to chemicals. And then what is scheduled is the semen analysis. And it’s approximately anywhere from a two up to five day period of abstinence from the time of collection previous. And that’s the ideal time where it maximizes the sperm function numbers.
And what we’re looking at are the concentration of sperm, we’re looking at the motility, the movement of the sperm and we’re looking at the overall shape of the sperm which is termed the morphology. And the sample is obtained. It’s a clean specimen sample, usually through masturbation and intercourse can be done but there has to be a special condom so you can catch the sperm and it has no chemical exposure. And the collection is done, the sperm is processed. It takes like a day or two for the results. And then the male patient is notified about the overall sperm function. It’s graded and then depending upon whether it’s completely normal, we may leave it and not follow up again. If we have some of the parameters that are lower, then we may actually repeat and bring them back for a comparison sample. Which is often done. And if the numbers are low, then that may lead to hormonal bloodwork to look at testosterone levels, to look at FSH, LH levels, to look and see is there issues either at the testicular level or elsewhere in the body that may be contributing to the decreased sperm values.
Host: So, then if you’ve determined that they have an issue whether it’s concentration, morphology or motility as you said; what are some of the options for them and who do they see for these issues?
Dr. Martinez: The abnormal semen analysis will be followed by bloodwork. If the bloodwork profile results tell us that the patient may benefit by taking medications, then some of the medications are used to increase the stimulus signal for the sperm to be produced. And so, oftentimes, the treatment is done in coordination with a urologist who has been trained in male infertility and we work with them together to make sure there’s nothing structurally going on. They undergo maybe an ultrasound of the testicles, a detailed physical examination and some other imaging that may be occasionally done and then we work and either provide hormonal treatments either through oral medicines or sometimes injectable medicines in the candidates who have low hormone levels that we think may benefit from these medicines. Oftentimes, that can be used in a trial period of one month up to three or even six months can be used to check for improved sperm function after treatment.
Host: As we wrap up, this is really important information and as I said at the beginning, not one we talk about typically on this show; what would you like couples to know that are coming to see you and looking at their fertility options and it turns out that the man is the one with some of these issues? What would you like them to know about what you can do for them, what they can expect and some of the outcomes that you’ve seen?
Dr. Martinez: Yes, so, I, first of all, want to just reassure them that when you have a male factor issue, as long as the semen analysis yields some sperm or in some cases very low numbers; we have the ability to use higher level fertility treatments such as in vitro fertilization. And under that treatment program, the eggs of the female can be artificially injected with sperm. It’s called ICSI procedure, I-C-S-I and that has an amazing ability to overcome severe male factor sperm function issues. In some cases, medicines can be taken to vastly improve the sperm quality. But the primary predictor of success is from the female side, the egg function and the ovarian function.
So, I always counsel patients and say I would rather be dealing with a sperm issues if I had to choose and have a lower quality sperm than vice versa and struggle from the female perspective. So, when I counsel couples accordingly, that everything is taken in part and parcel and then we determine how to best treat you that is not just one factor. I don’t want them to blame themselves for anything that they did but we just want to find out the information, reassure them and help them on their journey to start their family.
Host: That’s great information and thank you for that encouraging hopeful words for couples and thank you again for joining us Dr. Martinez. You’re such a great guest as always. And that concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information please visit www.fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and don’t forget to check out all the other great podcasts in our library. I’m Melanie Cole.
Melanie Cole (Host): Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I’m Melanie Cole and today, we’re discussing what to expect in the evaluation of male infertility. Joining me is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, always a pleasure to have you on. We don’t typically talk about male infertility with you so, tell us a little bit about it. How prevalent it is and what are some of the most common causes?
Alan Martinez, MD (Guest): As far as male infertility, it is one of the three overall categories that we check when we evaluate and undergo an infertility evaluation. And so, up to one third of cases, you can have of couples that are having issues with conceiving can be due to male factor infertility. So, it is very prevalent, and it is one of the basic tenets of our tests along with checking for the female structurally and then the reproductive hormones as far as the ovaries for the female. So, what usually happens is the tests that are done are two-fold. One, there is something called a semen analysis of where we look at the overall function of the sperm and then usually in addition to that, there may be bloodwork to look at the hormones, to look at the testosterone levels, to look at the profile of the male patient in relation to the sperm function.
Host: Can we bust up a few myths Dr. Martinez, because people have heard over the years various reasons. And I’d like for you to go over some of these, what might increase a man’s risk whether it’s lifestyle. Does tight underwear have a play in this? Does extended bike riding, cigarette smoking, alcohol, stress? Can you clear up a few of these for us?
Dr. Martinez: Absolutely. So, we know that some of the toxins or chemicals that a person can exposed themselves to specifically smoking, as far as other drug use, marijuana use can change the function of the sperm. All of these can have an effect on decreasing the overall sperm function. The extremes of temperatures saying like a patient uses saunas multiple days out of the week, very hot exposure to the testicles and overall temperature changes can lead to lower sperm function. Chemicals, job related chemicals; say a person is a construction worker, he like is involved in working with strong chemicals on the jobsite. That can potentially affect the sperm function. So, those are the environmental and chemical things that may lead to some subfertility as far as from the female perspective.
With regard to tight underwear, and or bicycle use; that overall does not statistically have an effect on the sperm function unless there is extended, extended exposure to maybe compression of the nerves through bicycling but underwear itself, is not going to effect the overall sperm function. It would have to be a very high level use of compression through cycling or other sports that would ultimately lead to decreased sperm function. Now much of that can bounce back with decreased activity and it can recover nicely in the male.
Host: Well thank you for clearing up some of those for us today. So, what can a man expect as he and his partner come in to get evaluated for their fertility issues? When you say that you are then going to do a semen analysis; tell us what that involves, and should the couple abstain from sex before the semen analysis? Tell us what an evaluation is like for the couple.
Dr. Martinez: Much like the female, there is an extensive history and a medical questioning to see if there is any of the risk factors like we talked about before, any issues with puberty, any attempts at pregnancy in the past, any prior miscarriages, live births, any changes in overall health and exposure to chemicals. And then what is scheduled is the semen analysis. And it’s approximately anywhere from a two up to five day period of abstinence from the time of collection previous. And that’s the ideal time where it maximizes the sperm function numbers.
And what we’re looking at are the concentration of sperm, we’re looking at the motility, the movement of the sperm and we’re looking at the overall shape of the sperm which is termed the morphology. And the sample is obtained. It’s a clean specimen sample, usually through masturbation and intercourse can be done but there has to be a special condom so you can catch the sperm and it has no chemical exposure. And the collection is done, the sperm is processed. It takes like a day or two for the results. And then the male patient is notified about the overall sperm function. It’s graded and then depending upon whether it’s completely normal, we may leave it and not follow up again. If we have some of the parameters that are lower, then we may actually repeat and bring them back for a comparison sample. Which is often done. And if the numbers are low, then that may lead to hormonal bloodwork to look at testosterone levels, to look at FSH, LH levels, to look and see is there issues either at the testicular level or elsewhere in the body that may be contributing to the decreased sperm values.
Host: So, then if you’ve determined that they have an issue whether it’s concentration, morphology or motility as you said; what are some of the options for them and who do they see for these issues?
Dr. Martinez: The abnormal semen analysis will be followed by bloodwork. If the bloodwork profile results tell us that the patient may benefit by taking medications, then some of the medications are used to increase the stimulus signal for the sperm to be produced. And so, oftentimes, the treatment is done in coordination with a urologist who has been trained in male infertility and we work with them together to make sure there’s nothing structurally going on. They undergo maybe an ultrasound of the testicles, a detailed physical examination and some other imaging that may be occasionally done and then we work and either provide hormonal treatments either through oral medicines or sometimes injectable medicines in the candidates who have low hormone levels that we think may benefit from these medicines. Oftentimes, that can be used in a trial period of one month up to three or even six months can be used to check for improved sperm function after treatment.
Host: As we wrap up, this is really important information and as I said at the beginning, not one we talk about typically on this show; what would you like couples to know that are coming to see you and looking at their fertility options and it turns out that the man is the one with some of these issues? What would you like them to know about what you can do for them, what they can expect and some of the outcomes that you’ve seen?
Dr. Martinez: Yes, so, I, first of all, want to just reassure them that when you have a male factor issue, as long as the semen analysis yields some sperm or in some cases very low numbers; we have the ability to use higher level fertility treatments such as in vitro fertilization. And under that treatment program, the eggs of the female can be artificially injected with sperm. It’s called ICSI procedure, I-C-S-I and that has an amazing ability to overcome severe male factor sperm function issues. In some cases, medicines can be taken to vastly improve the sperm quality. But the primary predictor of success is from the female side, the egg function and the ovarian function.
So, I always counsel patients and say I would rather be dealing with a sperm issues if I had to choose and have a lower quality sperm than vice versa and struggle from the female perspective. So, when I counsel couples accordingly, that everything is taken in part and parcel and then we determine how to best treat you that is not just one factor. I don’t want them to blame themselves for anything that they did but we just want to find out the information, reassure them and help them on their journey to start their family.
Host: That’s great information and thank you for that encouraging hopeful words for couples and thank you again for joining us Dr. Martinez. You’re such a great guest as always. And that concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information please visit www.fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and don’t forget to check out all the other great podcasts in our library. I’m Melanie Cole.