Men and women can both be affected by infertility and have difficulty conceiving a child. Male infertility affects 10-15% of men in the U.S. In couples struggling with infertility, male infertility is a factor 50% of the time.
It is recommended that both the male and female partners be evaluated simultaneously if there are difficulties achieving a pregnancy. This applies after one year of trying if the female is under 35 years old, or after six months if she is 35 years old or older.
Causes
Male infertility can be caused by problems with sperm production or function, blockage or hormone issues. The most common reversible cause of male infertility is a varicocele, which is a swelling of the veins that drain the testicle. Other health conditions, genetic disorders, prior surgeries, injuries, illnesses, medications, testosterone replacement or steroids, lifestyle choices and environmental factors may also play a role in male infertility.
Signs and Symptoms
Most men with infertility do not experience any signs or symptoms, except for the inability to achieve a pregnancy with a partner. However, signs and symptoms can include:
- Low sex drive
- Erectile dysfunction
- Reduced facial or body hair
- Difficulty with ejaculation or low volume ejaculate
- Pain, swelling or a lump in the scrotum
- Small testicles
- Abnormal breast growth
Diagnosis
Men should see a urologist who specializes in male infertility if there are any concerns related to fertility.
A male infertility evaluation may include:
- Detailed history: Identifies any medical, surgical, lifestyle or environmental factors that could contribute to infertility
- Comprehensive physical exam: An examination of the penis, urethral meatus, scrotum, testicles, vas deferens and spermatic cord
- Semen analysis: Provides information on the sperm count, shape and motility (movement)
- General health maintenance labs and hormone labs: Blood tests that help identify any medical problems, including hormone problems
Additional tests that may be considered in specific scenarios include:
- Scrotal ultrasound: Imaging that looks for scrotal abnormalities that are difficult to assess on physical exam
- Transrectal ultrasound: Imaging that checks the prostate and looks for blockages
- Post-ejaculate urinalysis: A urine sample that determines if sperm travel backward into the bladder instead of through the penis during ejaculation
- DNA fragmentation: A blood test that assesses the quality of the sperm
- Genetic testing: Blood tests that look for problems inherited from family
Treatments
The type of treatment a man receives for infertility depends on the underlying cause. In certain cases, treatment may not fully resolve infertility but can improve the chances of success with assisted reproduction.
Common treatments used for male infertility include:
- Lifestyle changes that promote health and well-being
- Hormone medications that improve hormone levels and sperm production
- Surgery to repair any abnormalities or damage to reproductive structures
- Sperm retrieval to obtain sperm directly from the testicle or epididymis
- Intrauterine insemination (IUI): An assisted reproductive technique that delivers sperm directly into the female partner’s uterus
- In vitro fertilization (IVF): An assisted reproductive technique that requires fertilizing the female partner’s egg with sperm and placing the resulting fertilized egg (embryo) into the uterus
In rare cases when male infertility can’t be treated and it’s impossible for a man to father a biological child, building a family may involve using a sperm donor or pursuing adoption.
How to Seek Help
There is hope for even the most difficult cases of male infertility. The following practices can help:
- UofL Physicians – Urology in Louisville: 502-588-4740
- UofL Physicians – Urology Associates in Shelbyville: 502-405-9450
