FDA Donor Screen: Surrogate Testing

The most common causes of male infertility are azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosisor a chromosomal abnormality.

The most common cause of female infertility is ovulation disorders. Problems with ovulation affect about 25% of all infertility situations. Other causes of female infertility include blocked fallopian tubes, which can happen when a woman has had pelvic inflammatory disease or endometriosis; Congenital anomalies (birth defects) involving the structure of the uterus, and uterine fibroids which are associated with repeated miscarriages; and aging, since the ability for ovaries to produce eggs tends to decline with age, especially after the age of 35.

FSH is the most important hormone level. FSH indirectly relates to sperm concentration and therefore can be helpful in determining whether lack of sperm production or obstruction is responsible for a low sperm concentration.

Hormonal testing for infertile males consists of testosterone and FSH. However men with sperm counts greater than 10 million/mL rarely have significant hormonal abnormalities and Testosterone levels are unlikely to be of any benefit. FSH values can be predictive for the outcome of any type of fertility treatment, including hormonal manipulation and/or varicocele repair. Therefore, FSH determinations may be beneficial in all men before undergoing any therapy, but testosterone determination probably should be reserved for men who have severe oligoasthenospermia and/or signs of hypogonadism including small testicular size. In the case of a low testosterone level, it is important to look at other hormones that may affect testosterone production, including prolactin, estradiol, LH and FSH. These hormones are typically best measured early in the morning.

Antithyroglobulin Antibodies (ATA) can cause problems with the function of your thyroid. These antibodies can disrupt other hormone levels, thus affecting egg production. Treatment for high ATA levels may consist of steroids. Antisperm Antibodies (ASA) can be found in both males and females. Males who have had vasectomy reversal or have injured their testicles can produce ASA (semen specimen) Female (blood test) ASA are found in the cervical mucus as well as in blood. The ASA attaches to the head of the sperm and make it hard for the sperm to penetrate an egg. IVF with ICSI treatment is recommended for couples with ASA. The Anti Phospholipids Antibody (APA) test is conducted if you have had multiple miscarriages. APA can interfere with the embryo implanting. APA disrupts the normal clotting of blood and the adhesion of the embryo to the uterus. APA tests for a number of different antibodies. If your test results show that two or more are positive treatment is either by baby aspirin or heparin. Antinuclear Antibodies (ANA) can increase your risk of miscarriage when the result is a low positive with a speckled pattern. If your result highly positive you may have a disease called systemic lupus erythematosus (SLE). A positive ANA level may be treated with low-dose steroids. Antiovarian Antibodies (AOA). This test is ordered when early menopause or premature ovarian failure are possible diagnoses. Natural killer (NK) cells of white blood cells that attack and destroy anything that is a foreign substance in the body. If the NK cell count is high these cells may be aggressive and attack a growing embryo. Treatment for NK cells is intravenous immunoglobulin therapy (IVIG). This can be very expensive procedure and controversial among infertility specialists. A drug called Enbrel can also be used to treat NK cells.

There are many factors that can contribute to male infertility. Some of these problems can be structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders. Perhaps it is best to break them out into 2 categories: Productive Factors and Obstructive Factors. In some cases of male infertility, the production of sperm is impacted whereas in obstructive issues cause problems with transporting the sperm to the semen. Here’s a breakdown of the many different types of male factor problems that can pose an issue to conceiving: Structural abnormalities It is possible that there can be an abnormalities of the reproductive tract, leading to potential obstructions that partially or totally block the flow of sperm and/or seminal fluid. Some of these abnormalities may be present at birth (congenital), others may have occurred after infection of the urogenital tract, whereas others may have resulted from previous surgery. Congenital defects Sperm production disorders This occurs when the production of the sperm is inhibited. Vasectomy Varicocele Sperm production problems Ejaculatory disorders These prevent sperm from reaching the female. Retrograde Ejaculation Impotence Immunologic disorders Immunological disorders can prevent sperm from meeting and successfully penetrating the egg in the female genital tract. Endocrine disorders Antisperm antibodies From RESOLVE: The National Infertility Association

Body Weight: Obesity is associated with infertility and a lower pregnancy rate in women undergoing in vitro fertilization (IVF). Women with a very low body mass index (BMI) also are more likely to experience infertility and have a lower likelihood of success with IVF than women whose BMI falls in the normal range. In men, obesity is also associated with infertility — sperm count and motility have been shown to be lower in obese men. Weight loss has been shown to improve semen parameters. Erectile dysfunction is more common in obese men. There is no scientific data that supports one diet over another with respect to maximizing fertility. Exercise: Some data that suggest that moderate exercise, regardless of BMI, is associated with the highest pregnancy rates in women. Daily exercise, however, has been shown to be associated with reduced fertility—especially if the excessive exercise results in menstrual irregularity. Exercise has a similar effect on men—one hour of exercise three times weekly seems to be associated with a higher count, motility, and normal appearing sperm than sperm from men who do not exercise and those who engaged in more frequent/vigorous exercise Caffeine Intake: Excessive caffeine intake (>500 mg/day) appears to be associated with a delay in time to conception. Consumption of moderate amounts of caffeine (200-300 mg/day) has been associated with lower pregnancy rates and higher rates of miscarriage. In one study, pregnancy rates with IVF were reduced in women consuming greater than 50 mg of caffeine daily. There is little data on the impact of caffeine on male fertility. The average 8oz cup of coffee has approximately 100 mg of caffeine, but not all coffees are created equal—look up the caffeine content of your favorite caffeinated beverage. Alcohol Consumption: Extreme alcohol intake has been associated with decreased fertility. What is less clear is the amount of alcohol it takes to negatively impact reproductive function. A review of the literature suggested that four drinks per week is associated with a decreased likelihood of successful IVF in women. Heavy alcohol consumption in men is associated with decreased sperm count, motility, and percent of normal appearing sperm. Some studies have shown a negative impact on sperm with more moderate drinking. Semen parameters have been shown to improve after three months of abstinence from alcohol. Smoking: There is strong evidence that nicotine negatively effects fertility. It has been suggested that women who smoke add ten years to their reproductive ages—a 30 year old smoker has the reproductive potential of a 40 year old! Smoking in men negatively impacts sperm quantity and quality and is associated with reduced success with IVF and intra-cytoplasmic sperm injection (ICSI). There is little scientific data on the impact of electronic cigarettes on fertility, but they contain nicotine, so they are likely associated with a decrease in fertility. Ideally, nicotine patches and gum should be avoided. Recreational Drugs: Studies on the impact of recreational drugs on female fertility are few. Women who use marijuana appear to be more likely to experience infertility. In men, marijuana has been found to increase ejaculation problems and impotence as well as reduce sperm count and motility. Most negative effects from recreational drugs have been shown to be reversed by discontinuing their use. Cell Phones: In some animal studies evaluating the effect of the radio-frequency electromagnetic radiation (RF-EMR) of cell phones on reproductive function, a negative impact on the ovaries, uterus, and embryo has been identified. Sperm exposed to RF-EMF have decreased motility and are more likely to have an abnormal appearance. The use of cell phones may decrease sperm concentration and motility as well as normal appearance. The abnormalities seemed to be directly related to the amount of use. However, there is no evidence that use of cell phones by women or men is associated with infertility. From RESOLVE: The National Infertility Association