Male Infertility

There are many factors that come into play in order for a woman to become pregnant. Male fertility is one of them.

What is Male Infertility?

Infertility is the inability to become pregnant, usually after trying for at least one year of unprotected intercourse. However, an infertility evaluation can be started at any point a couple has concerns. Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant. Males are a contributing factor in up to 50% of instances when a couple is trying but unable to conceive.

Under normal conditions, a man’s body makes tiny cells called sperm. During sex, the man ejaculates and the sperm is delivered into the woman’s body. For pregnancy to occur, the man’s body makes sperm which enters the female’s vagina. The sperm travels through her cervix into her uterus to her fallopian tubes. There, if a sperm and egg meet, fertilization happens, and pregnancy occurs. The process only works when genes, hormone levels, and environmental conditions are right.

What are the symptoms of Male Infertility?

A woman is unable to become pregnant after one year of unprotected sex with her male partner.

What causes Male Infertility?

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.

Sperm problems can be something you’re born with. Or your lifestyle can lower sperm numbers including smoking, drinking alcohol, and taking certain medications. 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). Certain medications can change sperm production, function, and delivery. These medications are most often given to treat health problems like arthritis, depression, digestive problems, infections, high blood pressure, or cancer.

Damage to the reproductive system can cause low or no sperm. About 4 of every 10 men have a blockage that prevents sperm from reaching the woman’s egg. A birth defect or a problem such as an infection can cause a blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can’t leave the body during ejaculation.

Swollen veins in the scrotum, called varicoceles, can cause male infertility. They harm sperm growth by blocking proper blood drainage.

Retrograde ejaculation occurs when semen goes into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm. It can be caused by surgery, medications, or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or “dry” ejaculation.

Sometimes a man’s body makes antibodies that attack his own sperm. Antibodies are most often made because of injury, surgery, or infection. They keep sperm from moving and working normally. We don’t know exactly how antibodies lower fertility. We do know they can make it hard for sperm to swim to the fallopian tube and enter an egg. This is not a common cause of male infertility.

Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels may cause poor sperm growth.

Sperm carries half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.

How is Male Infertility diagnosed?

Causes of male infertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis at Michigan Institute of Urology in Southeast Michigan begins with a full history and physical exam. Your physician may also want to do blood work and semen tests.

You’ll be asked about surgical history, childhood illnesses, current health problems, or medications; use of steroids, alcohol, tobacco, marijuana, and other recreational drugs; exposure to ionizing radiation, heavy metals, or pesticides.

Your physician will ask how your body works during sex and about your efforts to get pregnant. For example, your physician may ask if you’ve had trouble with erections.

The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor also will look for varicoceles (swollen veins in the scrotum). They can be found easily with a physical exam.

Semen Analysis: This routine lab test helps show the cause of male infertility. The test is most often done twice. Semen is collected by having you masturbate into a sterile cup. The semen sample is studied. It can be checked for things that help or hurt conception.

Your health care provider will study your sperm volume, count, concentration, movement (“motility”), and structure. The quality of your sperm talks much about your ability to conceive (start a pregnancy). For instance, semen is normal if it turns from a pearly gel into a liquid within 20 minutes. If not, there may be a problem with the seminal vesicles, your male sex glands. Lack of fructose (sugar) in a sperm-free sample may mean there are no seminal vesicles. Or it may mean there is a blocked ejaculatory duct.

Even if the semen test shows low sperm numbers or no sperm, it may not mean you are permanently infertile. It may just show there’s a problem with the growth or delivery of sperm. More tests may be needed.

Transrectal Ultrasound and/or Scrotal Ultrasound: Ultrasound uses sound waves bouncing off an organ to get a picture of the organ. Your physician can see if structures such as the ejaculatory duct or seminal vesicles are poorly formed or blocked.

Testicular Biopsy: If a semen test shows a very low number of sperm or no sperm, you may need a testicular biopsy. This test can be done in an operating room with general or local anesthesia. A small cut is made in the scrotum. It can also be done in a clinic using a needle through the numbed scrotal skin. In either case, a small piece of tissue from each testicle is removed and studied under a microscope. The biopsy serves two purposes. It helps find the cause of infertility. And it can collect sperm for use in assisted reproduction.

Hormonal Profile: Checking your hormones will indicate how well your testicles make sperm. It can also rule out major health problems. For example, follicle-stimulating hormone (FSH) is the pituitary hormone that tells the testicles to make sperm. High levels may mean your pituitary gland is trying to get the testicles to make sperm, but they won’t.

How is Male Infertility treated?

Treatment depends on what’s causing infertility. Many problems can be corrected with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into three categories:

Non-Surgical Treatments

Many male infertility problems can be treated without surgery.

  • Hyperprolactinemia: When the pituitary gland makes too much of the hormone prolactin, infertility and/or erectile function may occur. If medications are the cause, your physician may stop them. Drugs may be given to bring prolactin levels to normal. If a growth in the pituitary gland is found, you may be referred to a neurosurgeon.
  • Hypogonadotropic hypogonadism: When the testicles don’t make sperm due to poor stimulation by the pituitary hormones it causes infertility, occurring in only a small of men. It can exist at birth (“congenital”). Or it can show up later (“acquired”). The condition may have occurred at birth. Or it may have occurred due to other health issues such as:
    • pituitary tumors
    • head trauma
    • anabolic steroid use
  • Retrograde ejaculation: Semen flowing back instead of going out the penis, has many possible causes. It can be verified by your physician who will check for sperm in your urine.  Drugs can be used to correct retrograde ejaculation.

Surgical Treatments

  • Varicoceles (enlarged veins in the testicles) can be corrected with minor outpatient surgery. Fixing these swollen veins helps sperm movement, numbers, and structure.
  • If your semen lacks sperm because of a blockage, there are many surgical choices.
  • If a vasectomy is the cause for infertility, a reverse vasectomy can sometimes restore fertility.

Treatment when the cause is unknown

Sometimes it’s hard to tell the cause of male infertility and each case is different. Assisted reproductive techniques are ways to get pregnant without sexual intercourse. Based on the specific type of infertility and the cause, your physician may suggest:

  • Intrauterine Insemination (IUI): Your physician places the sperm into your 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): The egg of a female partner or donor is joined with sperm in a lab Petri dish. First the ovaries must be overly stimulated. This is often done with drugs. It allows many mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is put back into the uterus. IVF is used mostly for women with blocked fallopian tubes. But it’s being used more and more in cases where the man has very severe and untreatable low sperm count.
  • Intracytoplasmic Sperm Injection (ICSI): This is a variation of IVF. It has revolutionized treatment of severe male infertility. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it’s put in the female partner’s uterus. Your physician may use ICSI if you have very poor semen quality. It is also used if you have no sperm in the semen caused by a block or testicular failure that can’t be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method.
  • Sperm Retrieval for ART: Microsurgical methods can remove sperm blocked by an obstruction. The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract. These methods include Testicular Sperm Extraction which is a common technique used to diagnose the cause of no sperm. It also gets enough tissue for sperm extraction. The sperm taken from the testicle can be used fresh or frozen (“cryopreserved”). One or many small biopsies are done, often in the office.
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