New Treatments for Infertility 4

There are a lot of other reasons for male factor infertility and they pretty much follow all of the things of female ovulatory disorders. They are hypogonadotropic and hypergonadotropic. If you have low gonadotropins – usually we are talking about FSH – then you think of things that are more central. Anything from hyperprolactinemia, hypothyroidism, all the same things you think about in a woman. If they are hypergonadotropic, then you have to think of testicular failure. That is a situation where you are going to do a karyotype, just like you would in a woman if you were looking for, for example, Turner’s with hypogonadism, failed testicular function.

When I was a resident, we did post coital tests on absolutely everybody; even when I was a Fellow, we did it on almost everybody. The truth is, however, that it doesn’t make a lot of sense. The definition of a normal post coital is at least 10 to 20 normal motile sperm in the little swab that you take from the cervix, usually four to five hours after intercourse, without any white cells and with motility. The problem with this is that the only thing it tells you is that they are having intercourse. If there is a question and they are reticent to discuss it with you, if the issue is impotence or something else between the couple, this will help you determine whether or not there is penetration and an ejaculate in the vagina. Other than that, it doesn’t really tell you very much.
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How do you treat male factor? Primarily, you try to concentrate the number of sperm that you do have and then give it to her in an intrauterine insemination. Why not just put it in the vaginal intracervically? This question was answered recently in a New England Journal of Medicine article from about two years ago. There was a multicenter national trial in which they showed that in people who had ovulation induction, if you gave them intrauterine insemination (IUI) they had a three-fold better chance of getting pregnant with a confidence interval of 2.5 to 3.0. That was much better than if you did intracervical. People were randomized to all of these different groups. It was a very clean study with huge numbers – in the 300 to 400 range. So in general, we recommend doing intrauterine insemination now instead of just ovulation induction with intercourse to try to do the following. Basically, you have a sample and with an IUI, you spin down the sample, re-suspend it in a media that contains little beads usually, allow the sperm to swim up, which is essentially selecting from the best and strongest swimmers and then take the supernatant off, spin it down again and do the exact same thing over again so that you are going through the process twice and then taking those motile sperm, counting them, re-suspending them in 0.5 cc of media and injecting it into her.
Treatments for Infertility

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