Approximately 1 out of every six couples in the U.S. deal with issues of infertility. Infertility testing is recommended for those couples who have been trying for a year or more, unsuccessfully, to conceive a child. For women over 35, no pregnancy after 6 months of unprotected intercourse is cause for evaluation.
While often misunderstood as a mostly-female issue, in 35% of the cases male infertility is the primary factor. In 50% of cases, male infertility is a contributing factor. More often than not, the issue is in sperm production and/or delivery of the sperm. There are a variety of conditions which can impact sperm production, and a man’s ability to ejaculate sufficiently to deliver the sperm to its target (the woman’s egg). Very often, these conditions can be treated, and couples are able to achieve pregnancy.
Reasons for Male Infertility
Male infertility can be traced to certain pituitary or hypothalamus disorders, testicular issues, sperm transport disorders, and, in half of the cases of male infertility, the cause is unknown. While unknown causes are frustrating-in both male, and female infertility, it is common for male infertility to occur due to three very obvious reasons; there is not enough sperm, the sperm are impaired, or abnormal, or motility isn’t adequate, due to a problem with ejaculation.
A low sperm count can occur for the following reasons:
- excessive use of alcohol, tobacco, or drugs
- previous surgeries, such as to correct a hernia
- genetics
- hormonal imbalances
- radiation therapy
- serious mumps infection, post-puberty
- exposure to certain chemicals
- blockage due to infection or STD
- injury to groin or pelvic region
- tight, restrictive underwear
Abnormal sperm are typically caused by:
- inflammation of the testicles
- swelling of veins in the scrotum, known as varicocele
- testicles which did not develop normally or descend in puberty
Ejaculation issues include:
- premature ejaculation
- retrograde ejaculation, a condition in which the semen is forced back into the bladder, instead of out of the penis
- complications from a previous medical procedure or radiation therapy
- erectile dysfunction or ED
Testing for Male Infertility
A history of infections such as urinary-tract, or STDs, as well as certain medications, will also adversely impact your fertility. Often, if there are no obvious symptoms, some infections can go undetected leading to complications in fertility, among other issues. When male infertility is a suspected factor in a couple’s inability to conceive, evaluation and male fertility testing needs to begin, so treatment can commence.
Testing will begin with a thorough physical exam, including your health history, to look for factors which may have contributed to your infertility. Once the health assessment has concurred, testing will take place.
Physical examination of the scrotum, penis, and prostate is necessary to assess your genital anatomy. A blood test will determine the balance of your hormones. You will be asked to ejaculate so your semen can be tested for sperm count, viability and motility. This is called a semen analysis. You may also need to be tested for infections, such as STDs, and this will involve making a culture of the fluid from your penis.
With the semen test we’re looking at the total volume of semen as this is a good way to determine whether you have a blockage, such as a blocked duct, a problem with the seminal vesicles, the gland that secretes the components of semen, or a prostate issue. This test also helps us determine if your sperm is of adequate size and shape (morphology), and active (motility), and shows us your sperm count.
Further tests may be necessary, or suggested, in order to determine treatment. In men with low sperm counts, there may be an assessment of the endocrine system can help determine the course of treatment. Genetic evaluation of sperm is often called for to rule out any chromosomal abnormalities or genetic issues that may be passed on to future children. DNA evaluation is a follow-up test typically suggested to men who have a normal sperm count, no obvious abnormalities, but who are still experiencing infertility.
Treatment Options
Obviously, depending on the outcome of the testing, treatment options vary. For instance, in the case of varicocele or an obstruction which prevents the sperm from its intended goal, surgery can be indicated. Surgery is particularly successful in the case of a visible and large varicocele. In some instances sperm can be directly obtained from the testicles, via a biopsy procedure, and used in IVF (in-vitro fertilization) treatment.
Hormonal issues that interfere with fertility can be treated through medication. Endocrine disorders, such as those affecting the pituitary, thyroid and hypothalamus, often respond well to medications, successfully restoring normal hormone production.
In many cases of male infertility, the best option for achieving pregnancy is through IVF, or for mild issues with IUI (intrauterine insemination). These methods of assisted reproductive technology are especially helpful when both partners’ fertility is a factor in their inability to conceive the “old-fashioned way.”
Vasectomy and Vasectomy Reversal
A vasectomy, undoubtedly, impairs a man’s fertility, though it was likely intentional at one point. Of the half million men who seek vasectomies each year, roughly 10% look into having the procedure reversed at some point in the future. As scar tissue forms and age becomes a factor, the odds of a vasectomy reversal being successful diminish greatly. If a reversal is sought within 10 years of the procedure there is a 30%-50% chance pregnancy will be achieved. After 10 years, those odds drop off significantly.
If you suspect male infertility factors in your inability to conceive, seek help right away. As with any health issue, the sooner you get help, the better the outcome.
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