Other Fertility Scenarios
NORMAL SEMEN ANALYSIS BUT STILL UNABLE TO CONCEIVE
Sometimes a couple who has been trying to conceive for at least a year end up having completely normal fertility test results from both the male and female sides. Some of this inability to conceive may be due to pure chance (that is, bad luck) and simply trying longer will eventually result in success. Other times there may be hidden factors that are not uncovered by routine semen analysis. Certainly there are physiologic aspects of male fertility that have not been discovered yet by scientific research and so cannot be currently tested for.
If no significant abnormalities are discovered after two normal semen analyses, and if fertility testing for the woman has produced normal results, a couple has several options:
• Optimize the environment for sperm production. Even if the results of the semen analysis fall within the normal range, it is never a bad idea to try to optimize male fertility potential as much as possible. This process of improving the environment for sperm production starts with the "Male Infertility Testing" section to make sure that all of the appropriate testing has been performed before moving on to the Sperm Book Camp. Simple noninvasive measures (such as beginning antioxidant supplementation, quitting smoking, and making healthful changes in lifestyle and diet) are recommended for all couples having difficulty conceiving. More invasive interventions (such as varicocele repair) are typically not recommended in men with normal semen parameters unless other problems were found.
• Sperm DNA testing. The "Advanced Sperm Testing" section of this website reviews testing that can look for elevated levels of DNA fragmentation (abnormalities in the sperm’s genetic material). This type of testing is not routinely recommended for couples who are having trouble conceiving. However, if no problems can be found on standard semen analysis and female fertility testing, it may be useful to check sperm DNA fragmentation levels.
• Female fertility treatments. If no problems are found on standard testing of both partners, then a commonly used approach is to begin fertility interventions from the female side, which can potentially increase the odds of conception with each cycle. Options include medications for the female, intrauterine inseminations, and in vitro fertilization. The "Female Fertility Treatments" section of this website discusses the basics of these interventions from the female side.
If a couple proceeds with interventions from the female side, the chances of these interventions being successful are often higher if the man’s environment for sperm production is optimized. Often a lot of time, money, and emotion is invested in these interventions, and it makes sense to be sure that the man’s semen is as optimal as possible before getting started. I therefore recommend that the male partner proceed with the sperm optimization plan in order to increase the couple’s overall chances of fertility success.
Recurrent Pregnancy Loss
Sometimes couples do not have an issue with getting pregnant but do have problems with maintaining a pregnancy. Although often due to female factors, some male factor issues can also contribute to recurrent pregnancy loss. Examples include abnormal sperm DNA fragmentation.
The "Recurrent Pregnancy Loss" section reviews this subject in more detail and the "Advanced Sperm Testing" section discussed sperm DNA fragmentation in more detail.
RECURRENT IVF FAILURE
Even in the best of circumstances, with good-quality embryos, failure rates for a cycle of in vitro fertilization (IVF) approach 50 percent due to persistently low implantation rates. Therefore, every effort should be made to improve sperm quality prior to an IVF cycle to increase the chances of success with the Sperm Boot Camp. Sperm DNA fragmentation testing may be indicated in couples who have failed two or three cycles of IVF for no apparent reason, or those who fail an initial cycle of IVF and had poor embryo quality or progression despite good egg fertilization. There is increasing evidence that elevated levels of sperm DNA fragmentation can contribute to recurrent IVF failure and especially impact embryo quality as well as miscarriage rates. See the "Recurrent IVF Failure" and "Advanced Sperm Testing" sections for more detailed information.
Approximately half a million vasectomies are performed every year in the United States, and between 3 and 8 percent of these men will change their mind and want to have more children in the future. Effective therapies are available to these men, including microscopic vasectomy reversals as well as sperm extractions combined with conventional in vitro fertilization or intracytoplasmic sperm injection. The "Fertility Following Vasectomy" section reviews these post-vasectomy fertility options in detail.