Infertility (Male)
Table of Contents
We understand how frustrating and heartbreaking infertility can be. About 1 in 8 American couples are affected by infertility issues, making it more common that people realize. There are many causes of infertility, however in up to half of infertile couples, male infertility plays at least a partial role.
Male fertility is more complex than many people realize. Fortunately, almost 90% of infertility cases can be treated with medication, surgery, or assisted reproductive methods such as intrauterine insemination and in vitro fertilization (IVF). Our fertility specialists have decades of clinical experience diagnosing and treating fertility problems. You can trust our team to guide you on your journey to successfully conceiving a child.
Causes of Infertility
Male infertility can be caused by many medical issues, including:
- Varicoceles (enlargement of the veins in the scrotum)
- Epididymitis (inflammation of the tube that stores sperm)
- Orchitis (inflammation of one or both testicles)
- STDs
- Retrograde ejaculation
- Tumors
- Undescended testicles
- Hormone imbalances
- Male hypogonadism
- Chromosome defects
- Erectile dysfunction
- Celiac disease
- Having a low sperm count, poor quality sperm or low sperm motility (slow-moving sperm)
Female infertility can be caused by many medical issues. The most common include:
- Polycystic ovary syndrome (PCOS)
- Hypothalamic dysfunction
- Premature ovarian failure
- Excess prolactin
Other possible causes of female infertility include:
- Tubal infertility (fallopian tube damage)
- Pelvic inflammatory disease
- Previous pelvic surgery
- History of ectopic pregnancy
- Pelvic tuberculosis
- Endometriosis
- Uterine fibroids
- Cervical stenosis
Diagnosing Male Infertility
Causes of male infertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis begins with a full history and physical exam. Your physician may also want to do blood work and semen tests.
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.
A semen analysis is a routine lab test helps show the cause of male infertility. The test is most often done twice. Your semen can be checked for things that help or hurt conception such as sperm volume, count, concentration, movement (“motility”), and structure.
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.
Treating Infertility
Your urologist may first recommend lifestyle modifications to help increase your fertility. If lifestyle changes are not working, we may decide to administer more advanced treatments including:
- Hormone treatment (e.g. testosterone replacement therapy)
- Surgery – Such as removing uterine fibroids or undergoing a varicocelectomy to remove varicose veins in the scrotum.
- Testicular sperm extraction (TESE) – This involves harvesting sperm from your testicles for insertion into your partner. MicroTESE is a refined process that enables your provider to collect sperm from anywhere in your testicles. It’s an effective treatment even if your sperm count is very low.
