In our last blog, When Sperm is a Fertility Issue, we discussed factors that can affect sperm quality, including lifestyle, medications, and illness. Some effects can be reversible, while others are more permanent. In this blog, we will discuss fertility treatment options for couples where sperm quality may be an issue.
If your partner’s semen sample is sufficient in count and quality, your doctor may suggest intrauterine insemination (IUI). On the day of your IUI, your partner will be asked to produce a sperm sample. His sample would be processed in the lab to select and concentrate sperm that are normal-looking and swim well. Your fertility doctor can deliver this selected sperm directly into your uterus with a sterile catheter when you are ovulating. Because IUI puts sperm directly into the uterus, even weaker swimming sperm have a better chance of reaching the fallopian tube, where an egg may be awaiting fertilization. Your doctor can time the IUI with natural ovulation or medication-induced ovulation.
Ovarian medications and IUI are often recommended first, because they are technically simpler and less expensive than IVF. But they are typically much less effective than IVF. In some cases, it may be counterproductive to delay the use of IVF in favor of multiple rounds of less effective treatments. It’s important to discuss these tradeoffs with your doctor.
Since the birth of the first in vitro fertilization (IVF) baby in 1978, treatment for infertility using IVF has improved dramatically. Patients today have more success with IVF than with simpler treatments, because it bypasses multiple fertility issues (follicle development, ovulation, fallopian tube obstruction, and poor sperm quality) all at the same time. With the advent of intracytoplasmic sperm injection (ICSI), a procedure used with IVF in which a single sperm is manually injected into a single egg, even men with sperm quality issues can conceive a child.
To fertilize an egg successfully via intercourse or intrauterine insemination (IUI), a relatively large number of sperm (tens of millions) with strong swimming ability are needed to make it to the fallopian tube and still have sufficient energy to fertilize the egg. In contrast, fewer sperm with less stellar swimming ability are needed for IVF, because they are placed in close proximity to the egg in the same dish.
For a procedure called intracytoplasmic sperm injection (ICSI), the male needs to have only one normal sperm per egg because a single sperm is injected into a single egg by the lab technician. Sperm that swim weakly, or not at all, are able to fertilize an egg when ICSI is used. In this way, the semen analysis results can help guide the doctor’s recommendation for your treatment.
Sometimes, when treating infertility, it makes sense to make a beeline for more aggressive treatments to save time, money, and emotional frustration. Even with IVF success rates exceeding 60% per cycle for the top US clinics, IVF is currently used by as few as 2% of patients who are likely to conceive using IVF. Some of this underutilization is due to the cost of IVF. Insurance providers are responding to pressure from patients to include IVF as a benefit, and providers are seeking ways to make IVF more affordable for their uninsured patients.
Even patients who can afford IVF are not always offered this option until they have experienced six to nine months of failure with less aggressive treatments. Especially, in older women, losing nearly a year in futile attempts becomes significant as natural fertility declines with each month. In the next post, we’ll explain IVF and why it should be a first-line treatment for more patients.