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Male infertility

Male infertility isn’t something you hear much about on the news, so you may be surprised to know that male infertility is almost as likely as female infertility to be involved in a couple’s inability to achieve pregnancy.

The good news is that most cases of male infertility can be resolved either by treating the problem or using fertility treatments. When this is not the case, a couple facing male infertility may turn to a sperm donor or adoption to help build their family.

How Common Is Male Infertility?

About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. Out of this group, the following statistics on the cause of infertility generally apply:

  • Thirty percent to 40% of couples will discover fertility problems in both partners.
  • About 20% of couples will discover fertility problems in only the man.
  • About 30% to 40% will discover fertility problems in only the woman.
  • About 10% of couples will not find a reason for their infertility (also known as “unexplained infertility”).
  • Of men diagnosed with male infertility, 10% to 15% will have azoospermia (a complete lack of sperm). Azoospermia is present in about 1% of the general population.

Male Infertility Diagnosis

Male infertility is usually diagnosed by a semen analysis. This relatively simple test involves the man providing a semen sample for a lab to evaluate. The lab uses this sample to measure the amount of semen and the number of sperm, and to evaluate sperm shape and movement.

Ideally, the test should be performed at least twice to confirm results.

Most of the time, basic semen analysis is all that’s needed to diagnosis male infertility. However, further testing may include:

  • A general physical exam by a urologist
  • Specialized semen analysis, including genetic testing of the sperm (looking for the presence of antibodies) and evaluation of immobile sperm (to see if they are dead or alive)
  • Blood work to check hormone levels, usually of FSH and testosterone, but sometimes also LH, estradiol, or prolactin
  • Genetic karyotyping, if recurrent miscarriage is a problem
  • Ultrasound
  • Post-ejaculatory urinalysis (urine testing), to check for retrograde ejaculation
  • Testicular biopsy
  • Vasography

Male Infertility Symptoms

If a couple doesn’t get pregnant after a year of unprotected intercourse, both the man and woman should be evaluated.

Unlike female infertility (where irregular periods may hint at a problem), obvious symptoms are not common with male infertility.

In some cases, hormonal problems may be suspected if a man has abnormal hair growth, low libido, or other indications of sexual dysfunction.

Risk factors for male infertility include obesity, age (over 40 — yes, men also have biological clocks), current or previous infection of an STD, smoking, or excessive drinking. Some medications may also impair fertility

Male Infertility Causes

Male infertility

Potential causes of male infertility are:

  • Complete absence of sperm (azoospermia);
  • Low sperm count (oligospermia);
  • Abnormal sperm shape (teratozoospermia);
  • Problems with sperm movement (asthenozoospermia);
  • Sperm that is completely immobile (necrozoospermia); the sperm may be alive and not moving, or they may be dead;
  • Problems with sperm delivery, due to sexual dysfunction, an obstruction, previous vasectomy, or retrograde ejaculation;
  • Problems with erections or other sexual problems.

There are a variety of conditions that may lead to male infertility. The most common cause of male infertility is varicoceles. A varicocele is a varicose vein found in the scrotum. The extra heat caused by the vein can lead to low sperm count and impaired sperm movement.

Sperm analysis

Male Infertility Treatment

Some causes of male infertility are treatable or correctable through surgery. Options for treatment may include:

  • Treatment with antibiotics, in cases of infection;
  • Surgical correction, in order to remove a varicocele, reverse a vasectomy, or repair a duct obstruction;
  • Medications or fertility drugs to improve sperm production.

In cases where the above treatments are unsuccessful, or when the cause for male infertility is unknown or untreatable, IUI treatment or IVF treatment may be suggested.

IUI treatment, where the sperm are transferred into the uterus via the cervix, is commonly used in cases of low sperm count or quality. IVF treatment may be suggested if IUI is not successful or appropriate, or if female infertility is a contributing problem.

In some cases, your doctor may recommend a procedure known as intracytoplasmic sperm injection (ICSI). Done as part of an IVF treatment, ICSI involves injecting a single sperm into an egg.

If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab. This would be done as part of an IVF treatment.

However, if none of these options are available, or if they are unsuccessful, your doctor may talk to you about using a sperm donor, or considering adoption, to help build your family.


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By Rachel Gurevich, Guide

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