Assisted Reproductive Technology and Male Infertility

Assisted reproductive technology (ART) refers to the overarching field of scientific procedures designed to increase the likelihood that sperm can fertilize a woman's egg successfully.

It's estimated that at least 8 million couples in the United States have issues conceiving a child. Male infertility problems contribute to 50 percent of cases overall.

An introduction to IVF

IVF works by gathering eggs from a woman's ovaries and then fertilizing the eggs with sperm in a lab. Sperm must first go through a process of "washing," where healthy and motile sperm are separated from dead or nonmotile sperm and from the seminal fluid, which contains proteins, enzymes and fluids that aren't required for this process.

After the egg is successfully fertilized, the resulting embryo is transferred into the uterus of the woman who plans to conceive.

The first birth of a baby by in vitro fertilization (IVF) was on July 25, 1978. Since then, it's estimated that more than 6 million IVF births have taken place around the world. This pioneering work carried out by Robert G. Edwards in the early 1970s to combat infertility caused by blocked fallopian tubes earned him a Nobel Prize.

Although originally developed to counter issues in the fallopian tubes, IVF has now expanded its role in assisted reproductive technology to include addressing male infertility, especially for men whose sperm have poor motility (movement), are low in concentration and are structurally abnormal.

IUI and male infertility

Although not strictly under the ART umbrella, intrauterine insemination (IUI) is another technique that can increase infertile men's chances of conception.

Again using washed sperm, IUI provides sperm with the major advantage of being placed within the female uterus, beyond the cervix, much deeper in the woman's reproductive system than would be achieved through intercourse. Successful IUI requires somewhere in the range of 5 million to 40 million motile sperm.

The procedure is timed to coincide with the ovulatory period in the menstrual cycle, which gives sperm a much better chance to fertilize an egg.

The success rate for this procedure is highly variable, but a United Kingdom study from 2000 claimed that about 13 percent of intrauterine insemination procedures result in a successful live birth. More recent reports of success rates of up to 20 percent have been published.

ICSI: Injection of sperm

Eighteen years after IVF led to the birth of a baby girl, a new technique was introduced: intracytoplasmic sperm injection (ICSI). During ICSI, an individual sperm is injected directly into the egg itself.

ICSI has the advantage that large numbers of healthy sperm are no longer required, and their motility and structural abnormalities are not important. One sperm is all that is required. As a result, ICSI is now used in most cases of IVF to ensure a greater chance of successfully fertilizing an egg.

Another reason that ICSI has become so popular is that it no longer depends on harvesting sperm from seminal fluid and then physically separating the healthy, motile ones from the unusable ones. As part of the ongoing development of this technique, scientists have found that live sperm from the vas deferens, epididymis and testicles work equally well.

The future of ART

Assisted reproductive technology has come a long way in the past 45 years, and research continues to bring new innovations all the time.

A lot of research is targeted toward female fertility issues, but one breakthrough of the past few years benefits men. It's called the DNA fragmentation index (DFI), which, according to researchers with Translational Andrology & Urology, "reflects the integrity of and the damage to the DNA, the genetic material of the sperm, thereby detecting potential sperm damage. It is considered a crucial indicator in evaluating semen quality." Finding correlations between DNA fragmentation and a man's sperm and its function provides doctors with the evidence they need to recommend IVF or ICSI.

The art of ART has changed the way we think about conception. Of 250 IVF babies born in 1985 in the United States, there were 81,478 live births in 2018 as a result of 306,197 ART cycles, almost 2 percent of all births.

Thanks to these medical breakthroughs, male infertility issues don't have to be the end of your hopes for conception. Talk to your doctor, who can recommend the next steps toward achieving your dream of starting a family.