Male Fertility Program

Approximately 40% percent of all infertility--the inability to initiate a pregnancy after one year of unprotected intercourse--is caused by a male factor.

It is the sole cause of infertility in about 20-25% of infertile couples, and in about another 20% of couples, male factor contributes to diminished fertility. Male infertility has many causes, which may be classified into three groups: (a) pre-testicular, (b) testicular, and (c) post-testicular. Examples of these include:

• endocrine disorders
• deficient sperm production
• injury to the testicle
• undescended testes on one or both sides
• childhood german measles infection
• blockage of the sperm delivery routes
• anti-sperm antibodies and varicose veins around the testicle (varicocele)

One key advance in our understanding of male factor infertility is a new and improved interpretation of sperm concentration and motility values. We know now that these semen values do not necessarily predict male fertility. There are men with low sperm concentrations but normal sperm fertilizing potential, as well as men with normal sperm concentrations who show diminished fertility.

• Semen Analysis
• CkTesting
• IVF Program
• ICSI
• Sperm Cyropreservation
• Family Management Program
• The Physicians of the Male Fertility Program

Semen Analysis

The Yale Sperm Physiology Laboratory, established in 1983, is a leading Andrology laboratory, with national and international reputations for the excellence of both its clinical and its innovative research programs. We specialize in clinical evaluation and treatment of couples with male factor infertility, and in research aimed at developing new approaches for such evaluation and treatment.

Our laboratory performs the most sophisticated computer assisted semen analyses, anti-sperm antibody testing, and sperm morphometry/morphology evaluations. In addition, it offers the sperm migration test, which provides an assessment of the progression efficiency of sperm available for fertilization, and tests the maintenance of sperm motility. Another feature--a result of award winning research--provides a measure of sperm fertility based on the measurement of a sperm protein which is present only in fertile sperm. This test is useful in the diagnosis of unexplained male infertility, a condition in which fertility is diminished despite normal sperm concentrations and motilities.

These tests offer several advantages. For instance, we can now identify fertile husbands having low sperm concentrations in couples who are infertile because of the wife's fertility problem. Such cases have often been misdiagnosed previously as male infertility, due to the husband's low sperm concentration, although a female problem, such as ovulatory dysfunction, was the source of the infertility. After reviewing the various sperm test results, we can now establish the husband's fertility status and also recommend the most efficacious mode of assisted reproduction for each individual case.

CK Testing

The Yale Sperm Physiology Laboratory offers the CK test, which determines sperm maturity and also provides information on sperm fertility. The CK test provides vital information for the treatment of all couples, since it demonstrates the level of fertility of the husband's sperm. As mentioned, this test is particularly valuable in the treatment of any couple in which the husband is treated for low motile sperm concentration via drugs or surgery. Alternatively, the CK test also identify men with "unexplained male infertility" who show normal sperm concentrations and motilities, but nonetheless have diminished sperm maturity, which results in diminished fertility.


IVF Program

The Sperm Physiology Laboratory offers comprehensive diagnostic tests and state-of-the art treatment for male infertility problems. The laboratory also interacts with the Yale In Vitro Fertilization Program team in order to develop the most feasible, efficient and cost effective treatments for couples with male factor infertility. Conditions such as low sperm concentration, low sperm maturity, inadequate or inefficient sperm motility, presence of anti-sperm antibodies, blockages in the male reproductive system and difficulties with low sperm production are commonly treated. After the diagnostic evaluation is completed, a therapeutic modality route is selected in collaboration with the patient's own physician, whether from the community or from the Yale Fertility Center.

ICSI

Intracytoplasmic Sperm Injection (ICSI) is a relatively new micromanipulation technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure overcomes many of the barriers to fertilization and allows couples with little hope to achieve a successful pregnancy. At Yale the ICSI procedure was first used in 1994 and the first successful birth was achieved in 1995.

Sperm Cryopreservation

In addition to a full range of diagnostic tests for sperm disorders, the Yale Sperm Physiology Laboratory also maintains a high quality sperm cryopreservation program. In addition to supporting the donor insemination or Family Managament Program, which was established in 1984, we freeze sperm for IVF couples, and assists men who, due to upcoming radiotherapy, chemotherapy or vasectomy, have a need to preserve their child-bearing potential.

Family Management Program

We introduced our donor insemination program in 1984. Every donor in our program is a young well educated healthy college or post college student. The semen samples are cryopreserved in our Sperm Physiology Laboratory and the samples are also stored there. The standards for selection and screening of the donors follow the recommendations of the American Society for Reproductive Medicine. All steps in the recruitment and collection of semen and in its subsequent cryopreservation occur under the guidance of the laboratory director. The cryopreserved samples are released only after 6 months of quarantine. Once a couple decides to enroll into our Family Management Program, we, with the participation of the couple, match the donor with respect to race, eye color, complexion, and RH blood grouping of the wife. In addition, we take into consideration religion, ethnicity and hobbies.

The physicians of the Male Fertility Program