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Severe Male Factor Infertility: What Are Your Options?

Anticipating the growth of your family is exciting but trying to conceive without success is a frustrating experience. After one year of consistent intercourse (six months for women over 35) and no pregnancy, it’s probably time to check both partners’ fertility.

Infertility impacts about 15% of couples of reproductive age. Your fertility can be compromised by a variety of reasons. Sometimes a woman experiences ovulation issues or a man has a low sperm count, for example. Often tests reveal your inability to conceive is related to more than one factor. Of course, a conclusive diagnosis requires both partners be tested.


Tests for Male Factor Infertility

For men, the tests that determine your fertility usually follow a course. You see your physician (or your urologist) for a general health exam. The doctor examines your genitals and discusses any health issues, chronic conditions, genetic problems, injuries or illnesses which may impact your fertility. Your sexual habits and development at puberty are part of the discussion, as well.

Once your doctor takes your medical history and examines you, it’s time for the semen analysis. A sample is obtained by masturbating to ejaculate in a special container. Alternatively, some men prefer a different way of collecting semen. Often your doctor provides a specialized condom to collect the sample during intercourse.

The lab examines your semen for three main factors; the number of sperm, how they move (motility) and their appearance (morphology). Your semen is also examined for signs of infection and other problems. From there the doctor may suggest further testing which could include these common tests:


  • Scrotal Ultrasound: This is an ultrasound of your testicles which checks for the condition of your testes and supporting structures. The ultrasound also rules out a varicocele.


  • Hormone Blood Test: A blood test measures the level of testosterone and other hormones necessary to sperm production and sexual function.


  • Urinalysis: The doctor performs this test immediately after ejaculation occurs. Any presence of semen in the urine indicates sperm traveling backward to the bladder.


  • Genetic Testing: If your doctor deems it necessary from your initial consultation or from your sperm count, you may need a blood test. This test looks for any changes in the Y chromosome which indicate a genetic or inherited syndrome.


Initial Treatment Options

Once your doctor reviews the results of your tests, they may schedule additional, more invasive, tests or arrive at a diagnosis. Treatment for male factor infertility depends on the diagnosis, but some of these treatments include:


  • Surgery: For the diagnosis of a varicocele or a blockage, surgery is required. If you had a prior vasectomy, surgery may reverse it. In some instances, there are no sperm present in the ejaculate even though your body produces sperm. In that case the doctor retrieves the sperm directly from the epididymis or testicles.


  • Antibiotics: In the case of an infection, your doctor treats this with antibiotics. When the infection clears, there’s a chance your fertility may be restored.


  • Treatment for Erectile Dysfunction or Premature Ejaculation: If the problem is getting the sperm to the egg, there are medications which can help.


  • Hormonal Treatment: Low levels of certain hormones are treated using hormone replacement medication. This helps restore fertility.



Assisted Reproductive Technology

Sometimes treatment for severe male factor infertility doesn’t work. When this occurs, you do have a few options.


  • IUI: If you are producing some sperm, you and your partner may choose intrauterine insemination. In this situation, the doctor takes a high concentration of sperm and inserts it directly into the uterus where it has a better chance of reaching the egg for fertilization to occur.


  • IVF: In vitro fertilization proves extremely successful in situations where the sperm are poorly motile or the count is low. The lab places the sperm in close proximity to the egg, aiding in fertilization.


  • ICSI: Intracytoplasmic sperm injection involves the selection of a single sperm and injecting it directly into the egg. For this procedure the doctor may retrieve the sperm directly from the testicle. ICSI is also used with frozen or cryogenically preserved sperm.


  • Donor Sperm: If no other option works, if there is risk of a genetic defect or for other medical reasons a couple may consider using donor sperm. Use of donor sperm is highly successful in cases of severe male factor infertility. You and your partner can use anonymous donor sperm from a healthy donor with no genetic issues, or a known donor who is approved as healthy.


For more on your options for severe male factor infertility, contact our office for a consultation. Our compassionate team works with you to find the best solution to grow your family.

TEL: 310-286-2800 | FAX: 310-691-1116