EMORY SHEDS LIGHT ON MALE INFERTILITY

November 1997

Media Contacts: Traci Simmons, 404/727-8599, tgsimmo@emory.edu,
Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

ATLANTA -- Infertility is a common problem and may affect up to 15 percent of all couples. It is also on the increase since more people are now waiting longer to start their families.

For years, infertility had been thought of as mainly a "female problem." However, studies have shown that male infertility is quite common and may be a contributing factor in half of all infertility cases. Many individuals, men and women, with minor fertility problems do not experience any difficulty in achieving pregnancy since their partners may be extremely fertile such that, between the two, fertility is possible.

Urologist Jerry Yuan, M.D., who specializes in male infertility at The Emory Clinic North and is assistant professor of surgery at the Emory University School of Medicine has some important information regarding current treatments for couples struggling with the issue of male infertility.

Dr. Yuan says, "It is not uncommon for some men to feel inadequate and disappointed when they find out that their sperm count is low."

Semen analysis, the most important test in the evaluation of male infertility; includes sperm count, sperm motility and a number of other tests. Additional tests such as special sperm function tests, blood tests and ultrasounds which may be performed as needed.

The causes of male infertility are numerous and some are simple and easily corrected. Other causes are more complex and possibly due to genetic factors. Overall, these causes can be divided into two groups: production problems and blockage/obstruction.

1) Production problems: varicose veins of the testicle or varicocele is the most common problem, it may lead to low sperm count or slow moving sperm. Other causes include medication or drug use, alcohol, smoking, hormonal imbalance, coexisting medical illnesses and genetic conditions.

2) Blockage/Obstruction: sperm production takes three months , two and a half weeks of which are spent traveling from the interior of the testicle to the outside. The distance over which sperm must travel is 15 to 20 feet, mainly through tiny, microscopic tubes called the epididymis. These tubes can be blocked by scarring or inflammation, however, the most frequent cause for blockage is previous vasectomy. Blockage can be corrected with reconstructive surgery or sperm may be retrieved directly for in vitro fertilization (IVF). IVF is a procedure during which eggs are removed from the woman's ovaries and fertilized with the manês sperm in the lab. The embryos are then transferred back to the woman.

The evaluation for male infertility is fairly simple in most men. Physicians start with a detailed medical history and physical exam. The male's partner often is asked to be present to provide additional information since she usually is being seen by a gynecologist as well. The next step includes two or three semen analyses and blood tests for male reproductive hormones. In addition, some cases may require procedures or tests such as ultrasound, dye test for tube blockage and testis biopsy.

"We have gained a large amount of insight into male infertility; however, there are a number of men, especially those with severe production problems, for whom we have no effective treatment," said Dr. Yuan. "In these men, unless the sperm production is completely absent, we can directly extract sperm from the testes and use them for IVF."

When couples are experiencing difficulty in trying to conceive, both husband and wife should be evaluated. It is not uncommon that both may have some minor abnormalities. Natural conception, which is our ultimate goal, may then be possible if either or both partners can be treated.

"It's important for any couples who are experiencing difficulties to be evaluated or attend workshops on fertility issues such as those sponsored by the Resolve organization," said Dr. Yuan.

### EMORY HEALTHCARE incorporates all of Emory's health services into an integrated whole. It includes The Emory Clinic and its 15 health centers, Emory University Hospital, Crawford Long Hospital of Emory University and Emory-Adventist Hospital at Smyrna.

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to hsnews@emory.edu.