Approximately one out of every eight couples struggle with infertility. For many couples, there can be more than one cause. A common misperception about infertility is that the problem typically lies with the female, while 50% of the time, fertility problems have a contributing male fertility factor.

If a couple has been trying to conceive without success for one year (or six months if both are over 35), there are likely fertility issues. It is helpful for the man and the woman to be evaluated by a fertility specialist.

Causes and treatments for male infertility

There are many causes for male infertility, but also many solutions. Natural reproduction between a male and female requires the male to be able to have an erection, an ejaculation (the release of semen with sperm), and the production of healthy sperm that can swim to and fertilize a female egg.

Male infertility may occur if there is a problem with any of these conditions. Treatments can help with natural conception; if natural conception is ultimately not possible, there are still many treatments for achieving conception with one’s partner.

Treatments for male infertility may include:

  • Medical therapies
  • Medical surgeries
  • Prescription medicines
  • Lifestyle modifications

The goal of male fertility treatments is to optimize sperm health and mobility to achieve pregnancy success with natural conception or assisted reproduction treatments (ART) with in vitro fertilization (ivf) or intrauterine insemination (IUI).

Causes of male infertility may include:

  • Hormonal issues
  • Genetic factors
  • Testicular problems
  • Varicoceles (dilation of veins in the testicles)
  • Environmental and lifestyle problems

Diagnosing male infertility

Diagnosing and treating male infertility starts with identifying the reproductive problems, analyzing underlying causes, and correcting or improving the medical conditions that impair sperm production or sperm health.

 

The diagnosis process begins with the following:

  1. Semen analysis. Semen analysis examines sperm health under a microscope. Samples are typically obtained via masturbation by ejaculation into a sperm container in a private room at a doctor’s office or home with a physician’s guidance to ensure the sample’s integrity.
  2. A physical examination and medical history analysis. Genitals are examined, and questions about sexual development during puberty and past and present sexual habits are covered, along with questions about inherited conditions, injuries, surgeries, chronic health problems, and any illnesses that could affect fertility.
  3. Male Fertility Tests. There are several tests for comprehensive evaluation of the sources of infertility. Tests will be recommended based on the semen analysis and medical history.

Sperm analysis in male fertility

Sperm health is evaluated on a variety of factors such as quantity, movement, and structure:

  • Quantity. Quantity refers to the number of sperm in a male’s ejaculate (the semen discharged in a single ejaculate). Too little sperm in an ejaculate makes it more difficult to achieve pregnancy because there are fewer sperm available to make the journey to an egg and succeed in fertilization.
  • Movement (motility). To reach and fertilize an egg, sperm must move and swim up the vagina, through a woman’s cervix, up into the uterus, and to the fallopian tubes. This movement is known as sperm motility. A male is most likely to be fertile if at least 40% of the sperm can move.
  • Structure (morphology). Normal sperm have long tails and oval heads. This structural design works to propel the sperm forward. Although the structure is not as important as sperm quantity or movement, the more sperm a male has with standard shape and form, the more likely a male is to be fertile.
Male Fertility Sperm Testing at Lane Fertility Institute in San Francisco, bay-area

Looking at a semen sample, an embryologist or fertility doctor will count the number of sperm in the sample, analyze sperm structure, and watch sperm movement. The laboratory will also check for signs of other problems, such as infections.

Sperm count can fluctuate significantly from one specimen to another; therefore, several semen analyses might be done over a period of time to ensure accurate results.

If analysis indicates that the male’s sperm is normal, a specialist is likely to recommend comprehensive testing of the female partner before recommending any more male fertility tests.

Male Fertility Sperm Count information

What are the causes of sperm disorders?

There are many different causes of sperm abnormalities, including:  

  • Anatomical abnormalities such as varicocele (varicose veins of the testicle) or history of an undescended testicle(s)
  • Hormone or pituitary gland problems
  • Genetic disorders such as being a carrier for cystic fibrosis or having an extra or misplaced portion of a chromosome
  • Medical problems such as a history of cancer or uncontrolled diabetes
  • Environmental and lifestyle factors such as heavy use of alcohol, tobacco, steroids, marijuana, or exposure to other chemical toxins
  • Use of testosterone or other workout supplements
  • Kidney, liver, or other infections, inflammatory conditions
  • Serious childhood illnesses
  • Childhood surgeries, including hernia repair or testicular injuries
  • Vasectomy

The physical exam and medical history

A physical exam and medical history intake are done to uncover fertility problems such as premature ejaculation, structural issues such as erectile dysfunction, or blockage problems that may cause male infertility.

Infertility symptoms

Infertility symptoms may include: 

  • Pain, swelling, or a lump in the testicle or groin areas
  • Problems with ejaculation, small volumes of fluid ejaculated, difficulty maintaining an erection (erectile dysfunction)
  • Urinary, bladder, or prostate symptoms such as urinary frequency, burning, incontinence, or difficulty voiding
  • Decreased facial or body hair
  • Abnormal breast growth (gynecomastia)
  • Depression, significant stress, or difficulty sleeping
  • Being older than 45 years of age

Varicoceles and forms of blockage in the genitals

Blockage in the genital tract might result from a genetic or congenital disability, scar tissue from surgery, an infection or inflammation from a sexually transmitted disease, or dilated veins in the scrotum (varicoceles).

Testicles and Male fertility health tips and care from Lane Fertility Institute

Testicles of different sizes, a complaint of tenderness or pain, and other factors may be signs of varicoceles and dilation of the veins within the scrotum. Varicocele is relatively common, affecting 15-20% of all males, and is the leading cause of male infertility. It is the most common cause of an abnormal semen analysis and is diagnosable during a physical exam. Sometimes an ultrasound test is done to provide more details of the testicular veins.

Varicocele surgery, performed by a reproductive urologist (doctor specializing in male reproductive organs), is an effective treatment for varicoceles. The testicle veins causing the problem can be clipped or tied, stopping blood from flowing through those veins. Soon other veins will accommodate the blood flow.

Azoospermia

The complete absence of sperm in the ejaculate is called azoospermia. The cause of azoospermia can be obstructive or non-obstructive. Obstructive azoospermia may be treatable with reconstructive surgery. Non-obstructive azoospermia typically requires sperm retrieval and in-vitro fertilization (IVF).

Male fertility tests

Fertility specialists may use some of the following tests and procedures to diagnose structural or medical issues that may be causing male infertility:

  • Scrotal ultrasound. High-frequency sound waves capture images of the inside of the testicles and other structures supporting the scrotum, revealing a varicocele or other problems.
  • Post-ejaculation urinalysis. If a urine sample contains sperm, it may indicate that the sperm are traveling backward into the bladder instead of out through the penis during ejaculation (this is called retrograde ejaculation).
  • Advanced semen tests. A DNA fragmentation test may be ordered to evaluate the DNA quality of the sperm.
  • Transrectal ultrasound. A small, lubricated wand is inserted into the rectum to examine the prostate and look for blockages in the tubes that carry semen.
  • Hormone testing. A blood test may be ordered that measures the level of hormones and testosterone. Hormones produced by the pituitary gland and the testicles play an essential role in sexual development and the production of sperm.
  • Genetic tests. When sperm concentration is deficient, there may be a genetic cause. Blood tests can uncover whether there are an odd number of chromosomes, unsuitable material from one chromosome to another, or subtle changes in the male Y chromosome. Genetic testing can be ordered to diagnose various congenital or inherited conditions.
  • Testicular biopsy. This procedure involves removing samples from the testicle to determine if sperm production is average and whether the fertility problem is caused by a blockage or another problem with the ability of sperm to move and transport themselves effectively.
San Francisco bay-area Infertility Tests with Lane Fertility Institute

Treatments for male infertility

There are many different treatments available to treat male infertility depending on the specific cause:

  • Surgery. Surgery can repair dilated varicose veins in the scrotum (varicocele repair), which often improves sperm quality and corrects infertility. Additionally, sperm retrieval procedures can help men with severely abnormal semen quality, those who are azoospermic (no sperm in the ejaculate), and those with disorders of erection or ejaculation. Surgery to reverse a vasectomy is also a treatment option for those who have had this procedure.
  • Hormone medications and treatments. Hormone medications can correct hormonal disorders in some cases. Treatments might include hormone modulators such as clomiphene citrate or gonadotropin therapy.
  • Treating infections. Antibiotic treatment might cure an infection of the reproductive tract.
  • Lifestyle adjustments. Healthier life choices reverse infertility in some cases. Tobacco cessation, decreased alcohol consumption, avoidance of testosterone and workout supplements, improved sleep, weight loss, and enhanced diet might be recommended.
  • Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as premature ejaculation or erectile dysfunction.
  • Assisted reproductive technology (ART). ART treatments include obtaining sperm through normal ejaculation, surgical extraction, or from donor individuals. The sperm is inserted into the uterus or used in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to achieve pregnancy.

Donor sperm is an option for severe male infertility

In some cases, male fertility is not possible. At that point, a couple may consider using sperm from a donor. Anonymous donor sperm can be obtained from a sperm bank and shipped to a fertility clinic for intrauterine insemination (IUI) or in-vitro fertilization (IVF). Lane Fertility Institute can advise and direct patients if this option is chosen.

When to see a fertility doctor

A urologist specializing in male fertility should be seen after about a year of trying to get pregnant or if the male partner has any of the following conditions:

  • Pain, discomfort, or a lump or swelling in the testicle area
  • A groin, testicle, penis, or scrotum surgery in the past
  • Erection or ejaculation problems or other sexual function issues
  • A history of testicle, prostate, or sexual problems
  • 45 years of age or older
San Francisco bay-area Sperm bank and sperm donor information

For a consultation at Lane Fertility to discuss male infertility factors or other fertility questions, contact LFI today.