Male Infertility

Infertility is a condition that affects approximately one out of every six couples. When the problem exists within the male partner, it is referred to as male infertility. Male infertility factors contribute to approximately 35% to 45% of all infertility cases.  A different page of this website provides information on female infertility.

Approximately 15-20% of couples attempting their first pregnancy meet with infertility problems. Most authorities define these patients as having primarily infertility if they have been unable to achieve a pregnancy after one year of unprotected intercourse. Over the past twenty years the data reveal that in approximately 35% of cases pathology is found in the man alone, and in another 20% both the man and woman's have a problem.

Male infertility normally involves the man's sperm, for example when the sperm is abnormal and thus it may have a shortened life span or the abnormality may prevent it from moving correctly and prevent the sperm's ability to reach the egg and fertilize it. 

A second sperm related factor is when there is a problem in the number of sperm produced or there is problem with ejaculation of the sperm. The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:

alcohol
drugs
environmental toxins, including pesticides and lead
smoking cigarettes
health problems
medicines
radiation treatment and chemotherapy for cancer
age
a genetic condition,
congenital disorders
severe illness, e.g. mumps
a hormone disorder

A scrotal varicocele is the most common causative finding in infertile men.  Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. It occurs in 6% of children at age 10, 13% of adolescents, 15 percent of males in the general population. However, varicocele has been observed in 35% of men with primary infertility and up to 80% of men with secondary infertility. Although many men with varicocele can father children, varicocele causes a progressive time-dependent decline in semen quality.

A third area of male infertility is ejaculation problems including premature ejaculation, retrograde ejaculation (which occurs when the semen is forced back into the bladder), drug related complications, and erection problems.

Sexual dysfunction has been reported in up to 20% of infertile males. Decreased sexual drive, erectile dysfunction, premature ejaculation and failure of intromission are all potentially correctable causes of reproductive failure. Decreasing libido and erectile dysfunction may reflect low testosterone levels with an organic cause. Performance anxiety is also often reported and often abated with reassurance.

Typically, testing for male infertility is simple and routine.

First, a medical history may be obtained since there are many factors that contribute to male infertility including (list adapted from Wikipedia):

Endocrine problems, i.e. diabetes mellitus, thyroid disorders
Hypothalamic disorders, i.e. Kallmann syndrome
Hyperprolactinemia
Hypopituitarism
Hypogonadism due to various causes
Drugs, alcohol
Testicular factors
Genetic defects on the Y chromosome
Y chromosome microdeletions
Abnormal set of chromosomes
Klinefelter syndrome
Neoplasm, e.g. seminoma
Cryptorchidism
Varicocele
Trauma
Hydrocele
Mumps
Vas deferens obstruction
Infection, e.g. prostatitis
Retrograde ejaculation
Hypospadias

After a medical history a semen analysis is the most common testing procedure for determining if there is a male infertility factor. Sperm is collected into a specimen jar and presented to a lab technician who examines the sperm under a microscope to evaluate the count, shape, appearance, and mobility. For the sperm count, the technician will be checking to see whether the sperm concentration is above or below 20 million sperm cells per milliliter of ejaculation fluid.

A urinalysis may be used to look for white blood cells which may indicate an infection. The urinalysis will also determine if there is sperm in the urine, which would suggest that there is a problem with ejaculation known as retrograde ejaculation.  If the medical history, physical examination, and semen analysis are normal, attention should be directed to the female partner before further evaluation of the man.

For definitions of the many infertility terms, please visit Terms and definitions.

Male infertility is most often treated by conventional methods that include one or more of the following:

Avoiding long hot showers, use of hot tubs or saunas, and tight fitting underwear or shorts.

Taking medications to help sperm production or remove infection

Taking hormones to help with a hormone imbalance

Undergoing surgery to correct a scrotal varicocele

Other treatments include:

Intrauterine insemination (IUI) is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. 

Artificial insemination may be used if the man’s sperm count is low. Sperm may be collected through more than one ejaculation. It is then manually placed in the female’s uterus or fallopian tubes to help facilitate conception.

In vitro fertilization is a procedure that may also be used to address male infertility factors. The sperm and egg are fertilized in a laboratory and then the fertilized egg is placed in the female’s uterus to help facilitate implantation.

If there is no sperm production or other functional problems with the sperm, donor sperm may be used to help facilitate conception. Donor sperm is obtained from a sperm bank and placed inside the female’s uterus or fallopian tubes through artificial insemination.

Artificial insemination involves the use of the husband's sperm for insemination.  It is particularly useful with low semen volumes or in cases where repeated post coital tests have shown cervical hostility. Therapeutic donor insemination is an option for couples with male infertility.

Gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), tubal embryo transfer (TET) and tubal embryo stage transfer (TEST), as well as other treatments are detailed at Infertility treatment.

A psychologist or other mental health professional, experienced in infertility and infertility options, can often be an invaluable resource to help the infertile person or couple.

For more about infertility and adoption and/or for more specific information on receiving psychological help and treatment, visit the websites and resources listed below and please feel free to contact me,. I have been helping people with infertility issues and adoption for over 35 years.