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Tuesday, October 20, 2009

Has the man become irrelevant in the age of assisted reproductive techniques?

With the incredible advances that have been made in assisted reproductive technologies directed at women, many patients and doctors alike ask me why should they bother with evaluating and treating male factor infertility at all.  As long as the man has a reasonable sperm count, they reason, the couple can have a baby using assisted techniques such as intra-uterine insemination (IUI), in-vitro-fertilization (IVF), or intracytoplasmic sperm injection (ICSI).  I think it is a reasonable question and one that is being asked with increasing frequency during this recent economic downturn.

True,  (ICSI) requires the presence of only one sperm, but while pregnancy and babies come from ICSI, the process, in comparison to natural pregnancy or even artificial insemination is, well, less-than-pleasant.  Here are some other reasons:

  1. ICSI, IVF, and IUI are very expensive procedures.  Male factor therapies are inexpensive, in comparison.  IUI costs ~$1000 per attempt while IVF or ICSI costs ~$15000 per attempt.  A varicocele repair costs ~$3500 total (varicocele surgery is usually insurance covered, even in New York where insurance companies do not cover fertility services).
  2. Correcting male factors enhances success rates for all the female directed procedures, including ICSI.  I suppose that if you were spending $20,000 per IVF attempt, you'd want to improve the odds of success as much as possible in your favor.
  3. IUI, IVF, and ICSI procedures are safe, but are associated with potential serious risks that male factor risks do not possess.  Such risks include twinning, hyperstimulation syndrome, and laboratory specimen mix ups (wrong embryo implanted, yes it happens).  Male factor treatments are very safe and never associated with life-threatening side-effects. 
  4. Male infertility is associated with certain life threatening health conditions in men, like testicular cancer & diabetes.  Often, an abnormal semen analysis is the only indication that such a condition exists.  Referral to a urologist could save his life.  Personally, I diagnosis 4 to 6 infertility patients per year with testicular cancer in my male infertility clinic in Long Island. When your baby is born, he or she will benefit from having dad around for a long time.  
  5. While a couple's motivation to have a baby is high enough to propel them to undergo painful, stressful, and expensive female assisted reproductive procedures, they'd rather get pregnant the old fashioned way if at all possible.  Correcting male factor infertility can help couples achieve this goal.
So in my humble view, men and our sperm are still relevant and will remain so despite the truly amazing advances in female reproductive medicine.

Dr Schoor