As we mentioned in a previous chapter, reproductive endocrinologists are often the first doctor to see the semen analysis and to stumble upon a possible issue. Given the reproductive endocrinologist’s focus is getting the couple pregnant through treatments to female patients, they will often be inclined to direct the couple to Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).
IUI is the process whereby sperm is injected directly into a woman’s uterus. The technique is considered minimally invasive, does not require the woman to use hormone therapy, and typically costs $300 - $3,000. IUI can plausibly lead to a live birth in the context of a male factor issue if there is a sufficient total motile count (often 3 - 5 million sperm) but success rates in this context with IUI are generally around 10% per treatment.
IVF is the process where a woman’s ovaries are stimulated with hormones to grow a large number of eggs. Thereafter, those eggs are surgically retrieved, then fertilized in a laboratory with a man’s sperm. Thereafter, the fertility clinic’s laboratory attempts to grow the resulting embryos to a stable and hearty state, then transfers them back into the woman’s uterus.
Each cycle of IVF typically cost $18,000 - $23,000, most patients consider the process to be daunting and, as you can see below, most successful IVF patients must undergo multiple cycles. While many couples with a male factor diagnosis are told IVF has high rates of success, most will still require at least two treatments.
Few male factor patients are seen by a reproductive urologist, who will focus on treating the man’s underlying issues. Instead, male infertility is often ignored as the couple is ushered directly to IVF with ICSI. In this course we train patients to ascertain if they’re being treated by the proper clinician and whether IVF or ICSI are appropriate measures. We’ll cover the data on where the semen analysis is helpful and unhelpful, and the non-surgical ways fertility can be improved by correcting lifestyle habits and hormone imbalances. Patients will also understand when and how intervention is appropriate to remove varicocele and work around azoospermia.