Case Study: Male Factor Infertility and IVF Outcomes

Abstract

Male factors contribute to nearly 50% of infertility all over the world; however, their research is highly underinvestigated compared to female factors. Here, a case study is being reported on one 36-year-old male with severe Oligoasthenoteratozoospermia (OAT), which is one of the common causes of male infertility. The couple conceived successfully through IVF with ICSI. The case emphasizes the importance of early diagnosis of male infertility, discusses the role of ART, such as ICSI, and highlights the influence of lifestyle changes on sperm health.

Introduction

Infertility affects around 15% of couples worldwide, and male factor infertility is responsible for nearly half of these cases. Nevertheless, male infertility continues to be a largely neglected and undertreated condition. The etiology of male factor infertility is complex, and its determinants include genetic anomalies, hormonal disturbances, lifestyle factors, and exposure to some environmental insults. One of the most common diagnoses in male infertility is oligoasthenoteratozoospermia, which is characterized by both low sperm count and poor motility together with abnormal morphology.

IVF-ICSI is now a common stay of treatment provided to couples who are suffering from male factor infertility. This is a case report on the history of a couple suffering with severe OAT resulting in male factor infertility; where pregnancy was achieved by IVF-ICSI.

Patient Information

• Age: 36 years
• Gender: Male
• Medical History: Diagnosed with severe oligoasthenoteratozoospermia (OAT), No significant medical comorbidities
• Social History: Married, no previous children, Non-smoker, consumes alcohol occasionally, No history of recreational drug use
• Occupational History: Works in a high-stress job, often involving long hours and exposure to heat
• Partner Information: Female, 32 years old, with regular menstrual cycles and no known reproductive issues

Clinical Findings

Initial Semen Analysis

• Sperm concentration: 5 million/mL (normal >15 million/mL)
• Sperm motility: 25% (normal >40%)
• Sperm morphology: 2% normal forms (normal >4%)

Diagnosis

• Severe Oligoasthenoteratozoospermia

Hormonal Profile

• Normal testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels, ruling out hormonal causes

Physical Examination

• Normal testicular size and consistency
• No varicocele or other physical abnormalities detected

Partner’s Fertility Evaluation

• Hormonal profile and ultrasound indicated normal ovarian reserve and no structural abnormalities.

Timeline

Initial Diagnosis and Treatment Options Discussion

• Date: January 2023
• Event: The couple presented with 2 years of unexplained infertility
• Semen analysis: Confirmed OAT as the cause of infertility
• Action: Referred for assisted reproductive technologies (ART), specifically IVF with ICSI

Lifestyle Interventions and Follow-Up

• Date: March 2023
• Interventions: Advised to reduce alcohol intake, manage stress, avoid prolonged heat exposure (e.g., from laptops and saunas), and take antioxidants to improve sperm quality
• Outcome: No significant improvement in sperm parameters after 3 months

IVF-ICSI Treatment Initiated

• Date: June 2023
• Treatment: Ovarian stimulation and egg retrieval for the female partner; sperm sample provided by the patient
• Procedure: ICSI performed using the patient’s sperm to inject into retrieved eggs

Embryo Transfer and Pregnancy Test

• Date: August 2023
• Outcome: One high-quality embryo was transferred, resulting in a positive pregnancy test two weeks later

Diagnostic Assessment

Oligoasthenoteratozoospermia (OAT) Diagnosis

1. Semen Analysis: Severe OAT was found with very low sperm count, poor motility, and abnormal morphology in semen analysis. No infectious or genetic etiology was found. The hormonal level was in normal ranges.
2. Diagnostic Imaging: There was no varicocele or structural abnormality detected in a physical examination and ultrasound scan.

Partner’s Assessment

• Ovarian Reserve: The levels of the anti-Mullein hormone (AMH) are within the range of normal values; thus, a good reserve of ovaries is indicated. No structural abnormality was seen in the uterus or ovarian mass in the transvaginal ultrasound.

Follow-Up and Outcomes

Semen Quality Post-Lifestyle Modifications

The sperm parameters did not show any remarkable improvement even after changes in lifestyle measures such as reduction in alcohol intake, stress management, and antioxidant supplementation over three months.

IVF-ICSI Cycle

A total of 12 eggs were retrieved from the female partner. Of the retrieved eggs, 10 mature. All of the mature eggs underwent ICSI and then were successfully fertilized to develop 8 embryos. By day 5, 3 had reached the blastocyst stage, and 1 high-quality embryo was transferred.

Pregnancy Outcome

The female partner had a positive pregnancy test at 14 days post-embryo transfer. The intrauterine pregnancy with the appearance of a yolk sac was identified on early ultrasound and confirmed at 6 weeks gestation.

Discussion

This case therefore documents the use of IVF-ICSI among couples suffering from male factor infertility, especially in cases of severe OAT. Severe OAT accounts for a large proportion of male infertility, characterized by low concentration and poor motility, as well as poor morphology. Lifestyle changes involving less exposure to heat, stress control, and antioxidant therapy are often recommended. However, the improvements are rarely significant for all patients, and thus the a need for assisted reproduction through IVF-ICSI.

• ICSI and Sperm Quality: ICSI is the attainment of male-line infertility treatment by which fertilization may be possible if only sperm quality is impaired. Here, despite this patient having a very high degree of OAT, even ICSI succeeded in showing fertilization and potentially viable pregnancy.
• Impact of Lifestyle on Sperm Quality: Other studies indicate lifestyle factors such as alcohol consumption, smoking, and heat stress as harmful to sperm quality. In this case, though lifestyle intervention alone appears to be insufficient to improve semen parameters, any type of ART can be applied in severe cases of male infertility.
• Embryo Selection and Transfer: Embryo quality is one of the key determinants in the achievement of IVF. Once the appropriate blastocyst was chosen for transfer, the couple capitalized on the chance to conceive.

Takeaway

• Early Diagnosis and ART: Male factor infertility should be detected as soon as possible during the couple's workup. ART, and especially IVF-ICSI, can potentially become an alternative for infertile couples with male-related infertility, including the most severe cases of OAT.
• Multifactorial Approach: Medical, lifestyle, and technological management of infertility patients achieve optimum treatment results by working together. Lifestyle interventions are unlikely to influence semen parameters but play an important role in overall reproductive health.
• Patient-Centered Care: The best result and core principle of the management of infertility would be the concept of individualized treatment, about specific fertility profiles of couples, as evidenced in this case.

Patient’s Perspective

The couple was relieved and thankful for a successful pregnancy outcome. It was a long time of both emotional and physical grueling through the way of infertility treatment, especially after several failed attempts at conceiving naturally. The patient indicated that although the lifestyle changes recommended were doable, he felt discouraged by his minimal improvement in sperm quality. They were all in great spirits as they were pleased with the fruitful IVF-ICSI cycle and appreciated the personalized care that they received from their physician team. The client was more specific, emphasizing that this process does not just call for emotional support, which, indeed, is most necessary in that many financial, physical, as well as psychological aspects of an individual due to infertile treatments are considered very stressful. It therefore resulted in them being filled with inexpressible joy and hopefulness for their future family.

Conclusion

Male factor infertility has been considered an important cause of infertility among couples but is often underdiagnosed or overlooked. This case report presents early diagnosis and the effectiveness of IVF-ICSI in treating severe male factor infertility, like Oligoasthenoteratozoospermia. Although lifestyle modification is unlikely to bring any significant gain in semen quality for most individuals, technologies in ART are said to hold hope. Case success emphasizes the importance of individualized care and the imperative of assisted reproductive technologies, given the challenge of male-factor infertility.

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