Infertility and Men
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What is male infertility?
Infertility is the inability of a sexually active couple who are not using birth control to get pregnant after one year of trying. Infertility affects more than three million couples in the United States. Male problems may play a role in 30% to 50% of infertile couples.
What causes male infertility?
Many different conditions and physical problems can lead to infertility. In about 30% to 40% of cases the
problem is in the testes, the glands that produce sperm and testosterone (a male sex hormone). Chronic
illness, poor overall health, obesity, and abusing drugs may also decrease sperm production and fertility.
A common problem is enlarged veins around the testes (known as varicoceles). These veins raise the
temperature in the testes and can cause low sperm production in some men. Certain inherited genetic diseases can also cause low or no sperm production, or sperm that can’t swim and/or fertilize the woman’s eggs.
In about 10% to 20% of cases, the problem is a blockage in the sperm’s path from the testes to the penis. This can be caused by an infection, a vasectomy (surgery to cut the tubes called the vas deferens to prevent passage of sperm) or cystic fibrosis (a genetic disease). Backward movement of sperm into the bladder can also cause infertility.
Rarely (in less than 1% of cases), infertility is caused by a hormone deficiency. Luteinizing hormone (LH)
and follicle-stimulating hormone (FSH) are produced in the pituitary gland (located below the brain). LH
and FSH cause the testes to produce normal amounts of testosterone and sperm. Anything that lowers these hormone levels, such as a pituitary tumor, can result in low or no sperm production and low blood testosterone levels.
In 30% to 50% of cases, the cause of infertility is not known but is associated with sperm that are abnormal (e.g., slow moving, not shaped correctly, in low amounts, etc.).
How is male infertility diagnosed?
Doctors usually begin with a medical history of your childhood growth and development, past infections, surgeries, sexually transmitted diseases, damage to the testes or penis, and exposure to medications or
harmful chemicals.
A physical exam is done to look for signs of low testosterone or other conditions that affect fertility (e.g.,
small or missing testes), and a semen analysis (usually more than one) to look at the quantity, movement, and shape of the sperm. Blood tests are done to look for hormonal deficiency.
Your doctor might also use a scrotal or transrectal ultrasound to look for enlarged veins around the testicles,
tumors, or a blockage in the tubes that carry sperm from the testes to the penis.
Also, a medical history and full evaluation of the female partner should be done at the same time to get a complete picture of your ability as a couple to have children.
How is male infertility treated?
Treatment for male infertility depends on the cause. Surgery can be used to repair a blockage. Vasectomy is
one type of blockage that can be surgically fixed in up to 85% of cases, but many men remain infertile even
after the vasectomy is successfully fixed. Other types of blockage (such as those caused by past infections) can be harder to treat. Varicoceles can also be repaired surgically but surgery may not restore fertility. Repair of varicoceles is more likely to bring back fertility if the veins are large, or if the repair is done before any long term damage.
If the cause is hormonal, treatment with LH and FSH hormone injections is usually successful. However, it may take a year or longer of hormone therapy to get enough sperm production and bring back fertility.
Other options for a couple to achieve pregnancy include assisted reproductive technologies (ART) such as
inserting collected sperm into the womb, mixing sperm with an egg outside the body (known as in vitro
fertilization or IVF), or injecting a single sperm into an egg (known as intracytoplasmic sperm injection or ICSI).
What should you do with this information?
If you and your partner are unable to conceive, you should both be evaluated. A reproductive endocrinologist can help to diagnose and treat infertility. To improve your chances, however, it is helpful to maintain a healthy lifestyle that includes not smoking or using recreational drugs, improving diet and exercise habits, and treating chronic illnesses.