Infertility is increasingly becoming an issue for couples across the country. In fact, 15 percent of couples have trouble getting pregnant during their reproductive years. Often, couples are encouraged to wait to get a diagnostic workup by a fertility doctor until after they have tried to conceive for at least one year. Then, it is usually only the woman who receives diagnostic testing. However, 40 percent of infertility cases are either partially or solely caused by a male factor, according to the American Society for Reproductive Medicine. Fortunately, these couples are often able to achieve a successful pregnancy with the help of a fertility specialist.
What Causes Male Infertility?
For a woman to get pregnant, her partner must be able to produce enough healthy and functional sperm. Sperm levels—the most important measurement of male fertility—are declining throughout much of the world. A meta-analysis published in Oxford Academic, concluded that “sperm concentration had fallen by 52 percent among men in Western countries between 1973 and 2011.” So, what exactly is contributing to the recent decline in sperm count?
Some common causes of male infertility include:
- Varicoceles: A condition that causes the veins in the scrotum to swell, which can raise the temperature of the area and cause harm to the sperm.
- Infections: Any infection that causes inflammation of the epididymis or testicles can lead to infertility. Additionally, STDs such as gonorrhea and HIV can lead to permanent testicular damage.
- Undescended testicle: Congenital abnormalities including one or two undescended testicles could cause fertility issues in men. A birth defect or infection can cause total obstruction preventing any sperm from being created (azoospermia).
- Hormonal imbalance: Issues caused by the hypothalamus, pituitary, thyroid, and adrenal glands can cause a hormonal imbalance and hinder male fertility.
- Certain medications: Anabolic steroids, testosterone replacement therapy, antifungal medications, medication for ulcers, depression, high blood pressure, and many others may affect fertility.
- Retrograde ejaculation: If a man is suffering from retrograde ejaculation, in which the semen enters the bladder instead of being released from the penis, it can cause fertility issues.
- Environmental exposure: Overexposure to radiation, chemotherapy, heat, or industrial chemicals can lead to lowered sperm counts.
- Lifestyle factors: Common lifestyle choices that can affect sperm count include tobacco and other drugs, excessive alcohol consumption, stress, and hot tubs.
Diagnostic and Testing Process
Fertility testing for men often focuses on hormone levels, sperm counts, and other factors that may cause male infertility. While infertility can be stressful and frustrating for a couple, there is hope. In the last decade, great advancements to the diagnosis and treatment processes of male infertility have led to many more pregnancies than would have been possible in the past.
Typically, diagnostic testing is done by a urologist who specializes in male infertility. As soon as you or your partner suspects a problem, it is important to start the process right away, particularly if you are both over 35. The testing process typically includes:
History and Physical Exam
Your urologist will want insight into anything that may lower your chances of conception, so he or she will start with your medical history and administer a physical exam. Anything relevant will be covered in the medical history, such as past or current surgeries, sicknesses, accidents, and medications. Your urologist will also ask about your alcohol, tobacco and drug use, as well as personal questions regarding your sex life. Since all of these factors directly relate to fertility, it is important to be honest with your doctor.
A semen analysis will allow your urologist to observe your sperm count, volume, movement, concentration, and structure. This test also helps your doctor to understand what could be hindering fertility. Often, if abnormalities are found, more tests will be ordered.
If the urologist suspects that something could be blocking the ejaculatory duct or seminal vesicles, a transrectal ultrasound may be ordered. This test allows the urologist to view an ultrasound of the ejaculatory ducts by placing a probe in the rectum.
If a patient has a very low sperm count or no sperm at all, the urologist may recommend a testicular biopsy. This test involves a small incision being created in the scrotum to remove a small piece of tissue from both testicles. This test can be done under local anesthesia, then the samples are studied under a microscope. This procedure also allows the urologist to collect sperm that can be used in assisted reproduction.
A hormonal profile can help the urologist better understand how well your testicles produce sperm and also rule out other major health conditions. If high levels of FSH are present, the pituitary hormone responsible for creating sperm, it may indicate that something else is preventing the testicles from producing sperm.
Treatment Options for Male Infertility
The wide range of treatment options available today are very effective for most men. Typically, non-surgical treatments like oral medications, hormone injections, rectal probe electroejaculation, or vibratory stimulation is all that is needed to boost sperm count and improve fertility. However, there are surgical procedures available for more severe infertility cases. Common treatments for male infertility include:
Hormone Therapy Medications
Clomiphene, or Clomid, is a very common medication for male infertility. It is often tried first due to its non-steroid nature. This medication works to boost follicle stimulating hormones (FSH) and testosterone, which can increase sperm count.
Gonadotropin is another fertility medication that can stimulate the production of sperm and testosterone. Generally given as weekly injections, this medication contains FSH, LH or both.
If an overproduction of prolactin is causing infertility issues, Bromocriptine may be prescribed. This medication prevents the hormone prolactin from being released.
A varicocelectomy, or varicocele repair, works to restore swollen scrotal veins, or varicoceles. Varicoceles form in the scrotum when blood flow cannot move properly through a vein, causing it to swell and widen. This outpatient surgery is intended to enhance the number and movement of sperm, and 40-70 percent of varicocele repairs show improvement in sperm quality.
- Vasectomy Reversal
If a man has previously received a vasectomy and would like it reversed, there are a few different options. Vasovasostomy is the most common type of vasectomy reversal procedure, and it is the rejoining of the vas deferens to each testicle. A vasoepididymostomy is more complex and occurs when the vas deferens are reconnected to the epididymis due to a blockage.