Male Infertility & Reproductive Endocrinology

Many people think infertility is the result of "female problems."  However, male infertility is a factor for about 50% of people who have unsuccessfully tried to have children.  Infertility means that a couple is unable to have (conceive) a child after trying for a year or longer with frequent sexual intercourse without contraception.

Male infertility happens for numerous reasons.  There may be a problem or problems with the man's sperm quality or quantity, including a low number of sperm (low sperm count), malformed sperm, sperm that does not move or move enough, or blockages in the routes that sperm travel.  Additionally, lifestyle choices and health issues can contribute to male infertility. 

It is important for both the male and female in a couple experiencing infertility to be assessed.  Advances in reproductive medicine can make having children a reality for some infertile couples.  Although certain causes of female or male infertility cannot be changed, some causes of can be corrected.  Further, fertility may be assisted through artificial reproductive technology (ART).

In order for a woman to become pregnant, the man's sperm must be placed in her vagina where it can travel to her womb (uterus) and fertilize an egg produced by the woman.  Sperm carry genetic material necessary for human development.  Millions of sperm are produced in the male's testicles.  The testicles are located inside a pouch-like sac outside of the body (scrotum).

Sperm travel from the testicles in coiled tubes to the epididymis, where they fully develop.  From the epididymis, the sperm travel through the sperm duct (vas deferens) and combine with seminal fluid (produced by the seminal vesicles and the prostate gland) to form semen when a male is sexually stimulated.  During sexual stimulation, the penis becomes erect and the semen exits the penis, through the urethra, during ejaculation.

There are many different causes of male infertility.  It is possible to have more than one contributing factor.  Causes of male infertility may include:

• Age:  After age 35 men experience a gradual decline in fertility
• Anti-sperm antibodies
• Blockages that prevent the travel of sperm
• Celiac disease (digestive disease with sensitivity to gluten food products)
• Certain medications:  testosterone replacement therapy, long-term steroid use, chemotherapy, certain antibiotic medications, certain ulcer medications, certain anti-seizure medications
• Chromosomal abnormality
• Cigarette smoking
• Delayed or lack of ejaculation
• Emotional stress
• Erectile dysfunction
• Heavy alcohol consumption
• Heavy metal exposure:  lead
• History of groin, testicle, penis, or scrotum problems or surgery
• Hormonal imbalance: Low testosterone
• Illegal drug use
• Illnesses & chronic health problems
• Infections (inflamed testicles due to mumps, inflamed prostate "prostatitis")
• Injury
• Low sperm production (low sperm count)
• Men who are underweight
• Men with obesity
• Misshapen sperm
• Overheating the testicles:  saunas, hot tubs, tight clothing, seat pressure from prolonged bike riding
• Pesticide exposure:  thylene dibromide, organophosphates
• Radiation can reduce sperm production & take several years to return to normal, high doses of radiation can permanently reduce sperm production
• Retrograde ejaculation (sperm moves to bladder instead of out from the penis)
• Sexually transmitted diseases that can cause impaired sperm health or scarring that blocks the passageway of sperm: Chlamydia, gonorrhea
• Sperm that do not move (immobile sperm)
• Undescended testicles
• Varicocele (swelling in testicle vein that keeps sperm too warm)
• Vitamin deficiency:  Vitamin C, selenium, zinc, folate

Male infertility may be considered after the inability to conceive a child after more than one year of frequent unprotected sexual intercourse with a woman has taken place.

Assessments may include:

• Anti-sperm antibody tests
• Genetic testing
• Hormone evaluation including testosterone
• Physical examination
• Post ejaculation urinalysis- to determine if sperm move backward instead of forward (retrograde ejaculation)
• Specialized sperm function tests
• Sperm & semen analysis
• Testicular biopsy
• Ultrasound
• Vasography- to check for vas deferens blockage

Some causes of male infertility are correctable and some causes are not.  Some causes of male infertility are treated non-surgically with lifestyle changes.  Medical options may include hormone therapy or microsurgery.  For others assisted reproductive techniques can be useful.  Your doctor will discuss the most appropriate options with you in order to help you make informed decisions.

 

Lifestyle changes:
• Avoid tobacco smoking, marijuana, & cocaine
• Avoid alcohol, do not consume more than 2 drinks per day
• Avoid hot baths & whirlpools
• Avoid over-the-counter DHEA products for weight training

Medical
• Varicocele repair microsurgery
• Hormone medication
• Blockage correction surgery

Assisted Reproductive Techniques (ARTs):
• Intrauterine insemination (IUI):  Sperm are injected into the woman's uterus at the time of ovulation
• In-vitro fertilization (IVF):  Sperm from the man and eggs collected from the woman are placed together in the lab.  Resulting fertilized eggs are placed in the woman's uterus. 
• Intracytoplasmic sperm injection (ICSI):  A single sperm collected from the man is injected into an egg collected from the woman in the lab.  The resulting fertilized egg is placed in the woman's uterus.