Infertility is often attributed to women, but male infertility is remarkably common. The truth is that 30% of infertility is related to male factor problems. So while it’s critical to evaluate and correct any issues within the woman’s reproductive system, it’s equally important to address any issues within the man’s. In fact, a fertility specialist generally evaluates the man first.
Evaluating Male Factor Infertility
Initial evaluation of male infertility should include a detailed history of the male partner including current and childhood medical conditions, past history of infertility, frequency of intercourse, environmental exposures like heat or chemicals, and use of drugs like Testosterone or Marijuana. Past history of fertility should not exclude male fertility evaluation.
Signs of infertility in men is evaluated by semen analysis. This very simple test is typically done after six to twelve months of frequent, unprotected intercourse, depending on the female partner’s age. The test may be recommended earlier if there are other risk factors like a history of infertility with other partners or if the current partner has her own fertility issues. Through semen analysis, doctors are able to identify problems with:
- Semen volume (amount of semen)
- Sperm concentration (number of sperm per milliliter of volume)
- Sperm motility (percentage of live sperm)
- Sperm morphology (shape of sperm)
Many of these issues originate from problems with the testes, which may not be producing adequate testosterone or simply not generating enough sperm. Other causes can be secondary hormonal issues with the thyroid or pituitary gland. Some men may be in the process of being treated with supplemental testosterone by their primary doctor to correct fatigue, low libido, or erectile dysfunction. Ironically, this seemingly harmless supplementation can actually suppress sperm production.
In some cases of infertility in men, there can be anatomical problems such as obstructions of the sperm collecting system. A genetic disease like cystic fibrosis can cause absence of the vas deferens, which normally carries sperm from the testicles to where they can be ejaculated.
Treating Male Factor Infertility
Abnormal semen analysis should be repeated in about one month. It is not uncommon to find large sample to sample variation in the same person. At our fertility clinics in Scottsdale, Biltmore, and Gilbert we make individualized recommendations depending upon semen parameters found and clinical history from male and female partners. Some of the semen parameter abnormality can be treated with lifestyle modifications. Some with severe abnormality, such as persistent low volume, azoopsermia (complete lack of sperms in sample), severe oligospermia (less than 10 million sperms/ milliliter), or asthenospermia (low motility), will need further evaluation by a urologist.
Usual urological evaluation may include further detailed history, physical examination, laboratory evaluation of hormones and chromosomes as well as ultrasound. Depending upon the evaluation, many male infertility causes can be treated by a urologist with medical treatment (use of hormones or hormones modifying agents) as well as surgical procedures (vericocele repair). In certain cases of severe compromise of sperms, the urologist will need to obtain sperms with surgical procedures such as:
- PESA — Percutaneous Epididymal Sperm Aspiration (can be done in the office)
- TESA — Testicular Sperm Aspiration (can be done in the office)
- TESE — Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle — often done in a hospital or surgery center)
Due to advances in male infertility treatment, many cases of male infertility can be helped. Male infertility with minimum compromise of sperms parameters can be treated with Artificial Insemination (Intrauterine Insemination (IUI)). Even patients with severe compromise can be treated with Intra Cytoplasmic Sperm Injection (ICSI). For questions or more information contact us or call 480-946-9900.