Infertility, defined as the inability to conceive after one year of unprotected sex, can be a stressful, emotionally draining process for couples. One out of six couples experience infertility; a malefactor is fully or partially responsible in 30 to 50% of couples. Some male causes of infertility such as poor quality or low volume of sperm can be successfully treated.

What are the causes of male infertility?

The two main treatable causes are due to low production of good quality sperm or obstruction of the tracts which transmit sperm from the testicles to the urethra.

Varicoceles — a dilated group of veins above the testicles that elevate scrotal temperature and alter sperm production and quality. Varicoceles are present in about 40% of infertile men.

Obstructions — typically related to a prior vasectomy, hernia surgery, infection or inflammation.
Less commonly, sperm production can be affected by:

  • Hormonal disorders
  • Infections
  • Erectile or ejaculatory abnormalities
  • Genetic disorders
  • Environmental and lifestyle factors, such as smoking, alcohol or drugs, that cause “oxidative stress” reactive molecules that can damage sperm
  • Excessive heat — hot-tubs have been implicated

How is male infertility evaluated?

Generally, an evaluation is not needed until or unless you and your partner have failed to become pregnant after one year of consistent attempts. While issues are often identified in both partners, an infertility evaluation will usually start with the male partner. Your doctor will perform a thorough history and physical to look for factors that might cause infertility, including any anatomical problems in your reproductive system. The initial lab evaluation likely will include one or more semen analyses and hormone analysis. The semen analysis will include assessment of sperm count, motility (the percent of sperm actively moving), and morphology (the percent of sperm normally shaped). Other imaging tests may be ordered depending on the results of these initial tests.

How is male infertility treated?

Appropriate treatment will depend on the cause of the infertility. Treatment may involve surgery, assisted reproductive technologies, medications or lifestyle changes.

More common surgeries for male infertility include:

Varicocele ligation — varicose veins in the spermatic cord can usually be treated by varicocelectomy, an outpatient procedure that requires only a small incision. The treatment reduces blood flow through the abnormal veins and restores normal scrotal temperature.

Vasectomy reversal — using microscopic surgery, the previous vasectomy site on each side is identified and subsequently reconnected. The success rates for vasectomy reversal vary, but generally, 80-90% of men undergoing the procedure can expect to regain sperm in the ejaculate and up to 50% of couples will subsequently become pregnant. If intercourse does not result in pregnancy following vasectomy reversal, a collaborative effort with a woman’s fertility specialist usually can lead to pregnancy. Sperm retrieval and/or sperm processing sometimes can be used with various assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) to achieve a pregnancy with a high degree of success.

Medications

A range of disorders, including hormonal imbalances, infections, and erectile or ejaculatory abnormalities may be treatable with medication. Medication may help infertile men to produce more sperm when no identifiable cause for infertility has been found.

Lifestyle Changes

Changes in lifestyle may improve sperm production, including:

  • eating a healthy diet
  • stop smoking, eliminate drugs, limit alcohol

Your doctor may prescribe special vitamin supplements. Anti-oxidants such as Vitamins C and E sometimes improve sperm function and may be helpful for men with idiopathic (unexplained) infertility.