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Male Infertility

What is it?

Male infertility is when a couple has trouble getting pregnant after trying for around 1 year. Around 50% of infertility cases involve both a male and female factor that contributes to the problem. In total, up to 15% of couples cannot have a child even though they have frequent unprotected sex for at least a year.

For men exclusively, infertility can happen if sperm production is deficient, if his sperm has abnormalities of morphology or motility, or if the transmission of sperm is blocked on its way out of the body. Other common medical problems can also cause male infertility. This can be frustrating to experience, and a consultation with a Urologist is critical for diagnosis and treatment.

What are Contributing Factors of Infertility?

  • Age
  • Genetic Abnormalities
  • Erectile Dysfunction
  • Decrease Sexual Desire (Decreased Libido)
  • Chemical Exposures
  • Testicular Pain or Nodule
  • Decreased Semen Volume

What are the Causes of Infertility?

Endocrine and Systemic Disorders

  • This is a group of problems usually caused by the pituitary gland in the brain that signals to the testicles to make normal sperm. These disorders can include obesity, diabetes, a history of chemotherapy and/or radiation, or substance abuse (drugs, alcohol, or tobacco).

Spermatogenesis Defects

  • This is a group of problems where the body does not make the sperm correctly and they are unable to fertilize a female egg.

Sperm Transport Disorders

  • This is a group of problems with the “plumbing” that moves the sperm from the testes out of the body. This includes patients who have had a previous vasectomy.

Idiopathic Infertility

  • Idiopathic means that the cause of the problem is unknown. Up to 20% of men with infertility have normal sperm and no predisposing medical conditions.

How is it Diagnosed?

Usually the only obvious symptom a man will experience is the inability for him and his partner to get pregnant. If this happens, your doctor will start with a comprehensive medical history and physical exam. Blood work and two recent semen analyses are usually ordered to help determine a cause for infertility.

If these steps do not point to a problem, genetic testing may be indicated along with an ultrasound of the testes. In certain situations, a biopsy of your testicle may be needed.

What are the Treatment Options?

Problems with Intercourse

There are medications that can be prescribed for Erectile Dysfunction or premature ejaculation. If the problem has to do with a man’s mood or emotions, it might be helpful to consider counseling.

Hormone Treatments and Medications

Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses these hormones.

Surgery

If there is a blockage of sperm or a previous vasectomy, your doctor can perform a surgery to open the “plumbing” or perform a vasectomy reversal. In certain situations, sperm may need to be directly retrieved from your testicles or epididymis.

Assisted Reproductive Technology (ART)

This procedure involves obtaining sperm through normal ejaculation or surgical retrieval and then introducing this to the female genital tract or via in-vitro fertilization.

Frequently Asked Questions

When Should I See a Doctor for Infertility?

It is recommended that a man see a doctor to be tested if a couple cannot get pregnant after having unprotected sex for one year. If either you or your partner is over 35 years old, you should consider getting tested at six months.

How Do I Choose a Treatment?

After finding the cause of your infertility, your doctor will counsel you on appropriate options. Be sure to ask about success rates, cost of the treatments, recovery times of surgery, and any possible problems that could arise.

What if Treatment Does Not Work?

Deciding to undergo treatment is a very personal decision that you should make after discussing with your doctor. It is rare, but it can be possible that a man has an untreatable cause of infertility. Your doctor might suggest that you and your partner consider using sperm from a donor or adopting a child in this instance.