Treating Male and Female Infertility
This is an exciting time for male reproductive medicine and microsurgery in the Department of Urology at the UW School of Medicine and Public Health.
The Department has teamed with physicians and scientists in the Department of Obstetrics and Gynecology to create Generations Fertility Care, which opened in the fall of 2010. Infertile couples now have access to state-of-the-art evaluations and treatments of both male and female fertility problems in the same clinic.
By integrating the evaluation and treatment of the male with that of the female, UW Health urologists offer a unique program to treat infertility. This multidisciplinary clinic integrates services from reproductive endocrinology, urology, psychology and andrology. Combining these services has improved the coordination and delivery of care and has helped couples better understand the variety of factors that may be contributing to their reproductive problems.
Additionally, approaching infertility from a couple’s perspective, not just a male or female fertility perspective, has optimized the quality, efficiency and cost-effectiveness of treatments. Approximately 15 percent of couples are unable to conceive after one year of unprotected intercourse. Traditionally, infertility was thought to be due to female factors alone, but it is now better understood that infertility is not just a female problem.
A male factor is solely responsible in about 20 percent of infertile couples and contributory in another 30 to 40 percent. If a male infertility factor is present, it is almost always defined by the finding of an abnormal semen analysis, although other male factors may play a role even when the semen analysis is normal.
In 2006, urological services at UW Health expanded to include male infertility. Fellowship-trained staff offers full medical evaluations of the male, including evaluation and treatment of endocrine dysfunction, microsurgical repair of anatomic problems (microsurgical varicocelectomy, microsurgical reconstructions of the male reproductive tract including vasovasostomy and the more complex epididymovasostomy), treatment of ejaculatory failure by electroejaculation, testicular sperm extraction and cryopreservation, treatment of ejaculatory ductal obstruction and treatment of immunologic male infertility.
An important facet of male infertility is the impact of both cancer and cancer therapies on male reproductive potential. With the advances in cancer treatments, most young men with cancer survive into their reproductive years. Thus, the goals of cancer therapies now include not only survival, but also quality of life after cancer treatment.
However, most cancer treatments, including surgery, chemotherapy or radiation, can adversely affect a man’s fertility. In addition, cancer itself, especially testicular cancer, can put men at risk for infertility. As such, there has been increasing focus on the preservation of fertility in men with cancer.
Currently, the best strategy for fertility preservation in men of reproductive age with cancer is sperm cryopreservation prior to cancer treatments. Since the development of the UW Health male infertility program, the number of patients who have banked sperm has tripled. Continued efforts are being made to send this important message to the community, and researchers continue to investigate the mechanisms of cancer on fertility, as well as ways to better protect the gonads from the deleterious effects of cancer treatments.
A continually growing area of male reproduction science is the understanding of the genetics of male infertility. Karyotypic abnormalities such as Klinefelter’s syndrome, balanced translocations, Y-chromosome microdeletions and abnormalities of the cystic fibrosis transmembrane conductance regulator gene (CFTR) can all impact male reproductive potential.
Recently, much attention has been given to sperm DNA integrity and factors associated with sperm DNA damage. Even in men with a normal karyotype, meiotic abnormalities may result in sperm aneuploidy (wrong numbers of chromosomes in the haploid sperm). This is diagnosed with a sperm fluorescence in-situ hybridization (FISH) analysis.
Stem cell research as applied to male infertility also will allow for future therapeutic modalities to treat male reproductive problems. While the current rate of idiopathic male infertility is usually quoted to be around 25 percent, it is assumed that this number will decrease with the advent of advanced genetic analyses. The next era of genetic advances will be to identify and understand specific gene mutations that lead to infertility and develop strategies to treat these abnormalities.
UW Health urologist Dan Williams, MD, discusses aspects of infertility.