Male Infertility

Problems with sperm contribute to approximately 30% of infertility. Therefore, one of the first tests when a couple presents with inability to conceive is the semen analysis. In the semen analysis, several issues with sperm are looked at: sperm count (the number of sperm per volume, expressed as million per ml); motility (the percentage of sperm that are moving forward); morphology (the percentage of “normal-looking” sperm by strict criteria); acidity, viscosity, and the presence or absence of inflammation cells. Evaluation of the male by a qualified urologist experienced in male infertility should be offered as soon as significant abnormalities are detected in the semen analysis. In approximately 50% of cases where male factor is evaluated, the cause may be identified and treated. Fertility treatments are available even if the cause of male infertility cannot be identified or treated.

Causes of sperm count problems include:

• Unknown causes (at least 50%)
• Medications (especially testosterone, which can temporarily cause significant reduction in sperm performance. Marijuana and heavy alcohol or tobacco use may also adversely affect sperm, as is high doses of ibuprofen)
• Hormonal problems in the testicles or pituitary, or thyroid gland.
• Toxic chemical exposure (including pesticides and herbicides).
• Cancer treatment with certain kinds of chemotherapy, radiation, or surgery.
• Antibodies that attack sperm, commonly found after vasectomy reversal or as a result of testicular infection or injury.
• Chromosomal abnormalities (especially Y-chromosome)
• Structural problems. These include:
  • Varicocele (dilated veins in the testicles)
  • Scarring of the vas following infection, injury, or surgery.
  • Absence of a vas deferens (a birth defect that may be associated with the cystic fibrosis genes).
  •  Retrograde ejaculation (the ejaculation of semen into the bladder rather than out through the penis, common in diabetes, spinal cord injury, or after certain surgeries).

Treatment of male infertility:

• Appropriate evaluation by a male fertility specialist (urologist)
• Avoidance of factors potentially damaging to sperm (testosterone, excess heat, heavy alcohol, tobacco, marijuana, or ibuprofen use)
• Surgery (varicocele repair)
• Medications (e.g. clomiphene, anastrozole, letrozole)
• Artificial insemination
• In-vitro fertilization (IVF) with intra-cytoplasmic sperm injection (ICSI)
• Testicular sperm extraction (TESE) combined with IVF/ICSI
• Donor sperm insemination