Fam Medicine, Endocrinology/Diabetes
Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant. About 13 out of 100 couples can’t get pregnant with unprotected sex. There are many causes of infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with sperm production, or with sperm delivery. Male fertility depends on the body making normal sperm and delivering them.
CAUSES
Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility. These are the main causes of male infertility:
Sperm Disorders
Varicoceles
Retrograde Ejaculation
Immunological Infertility
Obstruction
Hormones
Medication
Sperm Disorders
The most common problems are with making and growing sperm. Sperm may:
Not grow fully.
Be oddly shaped.
Not move the right way
Be very low in number (oligospermia)
Absent (azoospermia)
Sperm problems can be from genetic issues. Lifestyle choices can lower sperm numbers. Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone problems (such as low testosterone).
Damage to the reproductive system can cause low or no sperm. About 4 out of every 10 men with a total lack of sperm (azoospermia) have an obstruction (blockage) within the tubes through which the sperm travel. A birth defect or a problem such as an infection can cause a blockage.
DIAGNOSIS
Causes of male fertility can be hard to diagnose. The problems are most often with sperm production, or delivery. Diagnosis starts with a full history and physical exam. The healthcare provider may also want to do blood work and semen tests.
History and physical exam
The health care provider will take the health and surgical histories. The provider would want to know about anything that might lower fertility. These might include defects in the reproductive system, low hormone levels, sickness, or accidents. The provider would ask about childhood illnesses, current health problems, or medications that might harm sperm production. Such things as mumps, diabetes and steroids may affect fertility. The provider would also ask about the use of alcohol, tobacco, marijuana, and other recreational drugs. He or she would ask if you’ve been exposed to radiation, heavy metals, or pesticides. Heavy metals are exposure issues (e.g. mercury, lead arsenic). All of these can affect fertility.
The physical exam would look for problems in the penis, epididymis, vas deferens, and testicles. The doctor would look for varicoceles. They can be found easily with a physical exam.
Semen analysis
Semen analysis is a routine lab test. It helps to show the level of sperm production and whether sperm are functioning well (e.g., are moving, measured as sperm motility). The test is most often done at least twice if sperm numbers are abnormal.
Transrectal ultrasound
The healthcare provider may order a transrectal ultrasound. Ultrasound uses sound waves bouncing off an organ to get a picture of the organ. A probe is placed in the rectum. It beams sound waves to the nearby ejaculatory ducts. The health care provider can see if structures such as the ejaculatory duct or seminal vesicles are poorly formed or blocked.
Testicular biopsy
hormonal profile
The health care provider may check the hormones. This is to learn how well the testicles make sperm. It can also rule out major health problems.
TREATMENT
Treatment depends on what’s causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into 3 categories:
Non-surgical therapy for male infertility
Surgical therapy for male infertility
Treatment for unknown causes of male infertility
Assisted reproductive techniques
If infertility treatment fails or isn’t available, there are ways to get pregnant without sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and cause, the healthcare provider may suggest:
Intrauterine Insemination (IUI). For IUI, the health care provider places the sperm into the female partner’s uterus through a tube. IUI is often good for low sperm count and movement problems, retrograde ejaculation, and other causes of infertility.
In Vitro Fertilization (IVF). IVF is when the egg of a female partner or donor is joined with sperm in a lab Petri dish.
Intracytoplasmic Sperm Injection (ICSI). ICSI is a variation of IVF. It has revolutionized the treatment of severe male infertility. It lets couples get pregnant though infertile.
Sperm Retrieval for ART. Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells.
Infertility is not the partner’s fault. The American Society of Reproductive Medicine (ASRM) estimates that in about a third of infertility cases, it is due to the male. Another third is the female. In the last third of infertile couples, the problem is caused by either a combination of reasons or, in 20 out of 100 cases, it can’t be explained.
In men, few or no sperm is the biggest problem. In women, the common problems are ovulation problems and blocked tubes. But today, technology and surgical tools exist to address many of these problems.
