Male fertility is not necessarily permanent, and whether it is treatable depends on the underlying cause. If the condition causing the infertility is treatable, your doctor may recommend a combination of treatment methods.
According to studies, approximately 10% of men suffer from infertility or have problems getting their partner pregnant. However, one-third of male infertility cases have no known cause.
If you have not conceived within a year of having unprotected sex, your doctor may order tests to diagnose the cause and suggest a treatment plan.
What causes male infertility?
Infertility can be caused by:
- Low sperm production due to problems in the testicles
- Abnormal sperm function
- Blockages that prevent sperm delivery
- Low production of luteinizing hormone and follicle-stimulating hormone due to problems in the hypothalamus and pituitary glands
Medical conditions that can cause infertility include:
- Hormonal disorders (disorders that affect your hypothalamus or pituitary glands)
- Genetic diseases
- Klinefelter's syndrome
- Myotonic dystrophy
- Cystic fibrosis
- Diabetes
- Some autoimmune disorders
- Some infections:
- Varicoceles (enlarged veins on the testes that cause them to overheat, which can affect sperm structure or count)
Other factors that can cause fertility include:
- Chemotherapy
- Radiation
- Trauma to the testes
- Surgical removal of the testes
- Anabolic steroids (taken for muscle building)
- Some medications and supplements
- Heavy alcohol use
- Tobacco consumption
- Recreational drug use
How is male infertility diagnosed?
After taking your medical history, your doctor will examine your genitals and ask you about your lifestyle, medical conditions, medications, and sexual habits. They may also order tests such as a semen analysis.
Before a semen analysis, you may be asked to stop having sex for 3-5 days and then ejaculate into a sterile container or condom. The collected semen is then sent to a lab to check for abnormalities of sperm count, shape, or movement.
Depending on the semen analysis results, your doctor may order one or more additional tests such as:
- Scrotal ultrasound (involves moving a wand with high-frequency sound waves over the scrotum to detect problems in the testes)
- Transrectal ultrasound (involves inserting a wand into your rectum to check the prostate and look for blockages in the tubes that carry semen)
- Hormone testing
- Genetic testing
- Post-ejaculation urinalysis
- Testicular biopsy (surgical removal of a small piece of testicular tissue to be analyzed under a microscope)
- Specialized sperm function tests
How is male infertility treated?
Treatment depends on your medical history, the cause of infertility, and your preferences.
Lifestyle changes
- Quitting smoking
- Limiting alcohol intake (to less than 2 drinks per day)
- Avoiding recreational drugs
- Eating a healthy diet rich in fresh fruit and vegetables
- Losing weight if overweight or maintaining a healthy weight
- Avoiding sitting in a very hot sauna or hot tub (above 102.5 F) for more than 20 minutes
Treatment of hypothalamic or pituitary deficiency
If problems with your hypothalamus or pituitary glands are affecting your hormone levels, your doctor may recommend gonadotropin treatment. This treatment involves getting injections of human chorionic gonadotropin 3 times a week for at least 6 months. The therapy is usually done for 1-2 years.
Treatment of varicocele
If you have a large varicocele, your doctor may recommend surgery to cut the veins connected to the varicocele. If you do not want surgery, you can opt for assisted reproductive technology, such as intracytoplasmic sperm injection (ICSI). With ICSI, only a small number of sperm are needed to fertilize the ovum outside the female body in a test tube.
Treatment of blockage or abnormality of the reproductive tract
- Vasectomy reversal (surgically reconnecting the vas deferens, which is the tube in the scrotum, through which the sperm passes)
- Vasoepididymostomy (surgery to remove blockages in the vas deferens)
- Sperm retrieval (a procedure to retrieve sperm)
Assisted reproductive technologies (ART)
ART can help if the semen analysis shows very low sperm count or no sperm at all. These procedures are quite expensive, however, and require a considerable amount of patience and energy.
In vitro fertilization (IVF)
In general, IVF involves the following steps:
- Collecting eggs from the ovaries
- Fertilizing them with sperm in a lab
- Transplanting the resulting embryo into the uterus
IVF success rates depend on several factors, including:
- Age and health of the female partner
- Health of the egg and sperm
- Experience of the infertility center
Intracytoplasmic sperm injection (ICSI)
This type of ART involves injecting a single sperm from the male partner directly into an egg in a lab. ICSI success rate depends on many factors, including:
- Fertility of the female partner
- Quality of the sperm retrieved from the male
- Experience of the infertility center
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Anawalt BD, Page ST. Patient education: Treatment of male infertility (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/treatment-of-male-infertility-beyond-the-basics
Dave CN. Male infertility. Medscape. https://emedicine.medscape.com/article/436829-overview
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