Male Infertility

At the Center for Reproductive Medicine, our experts work with specialists from the Men’s Wellness Clinic to identify aspects of male factor infertility.

Our team helps couples achieve their family building goals by:

• Identifying and correcting reversible causes of male infertility, with the goal of allowing a couple to conceive through intercourse or with the least amount of technology
• Finding irreversible conditions that may be treatable with assisted reproductive technology (ART) using the male partner’s sperm
• Recognizing irreversible conditions in when man’s sperm cannot be obtained, in which case the couple may consider donated sperm or adoption
• Understanding medical diseases that may be associated with infertility and require treatment
• Identifying specific genetic causes of infertility that can impact fetal development and/or be passed down to future children

In most cases, we recommended both partners get evaluated at the same time to prevent any delays in successful treatment. A male should consider medical evaluation sooner if there is a known risk factor for infertility or concern about their fertility potential.

These factors include:

• History of undescended testicles, hypospadias, urethral repair or genitourinary abnormalities
• Prior history of mumps orchitis, or testosterone or chemotherapy exposure
• Prior history of genitourinary trauma, or injuries or infection or surgery

What is the main cause of male infertility?

The causes of male infertility vary widely. We recommend being evaluated by a urologist who specializes in male reproductive health. Some causes of male infertility can be identified and reversed or improved with specific surgery or medication, while other causes can be identified but not reversed.

Occasionally, the underlying cause of infertility or an abnormal semen analysis cannot be identified, in which case it is termed ‘idiopathic.’ These cases may be amenable to non-specific or empirical treatment to improve the chances of conception.

How common is male infertility?

Infertility is defined as the failure to conceive despite one year of regular unprotected intercourse. About 15% of couples will experience infertility. About 20% of these couples will experience infertility that is solely male-factor related. Another 30% of couples will experience infertility that has a contributing male factor.

How is male infertility diagnosed?

Generally, male infertility is identified by abnormalities on a semen analysis. However, other issues can contribute to infertility despite normal semen.

What to Expect During an Evaluation

History and Physical Exam

A man’s evaluation begins with a thorough reproductive, medical, and surgical history. Critical components of this history include:

• Duration of infertility, timing and frequency of sexual intercourse, and sexual health
• Prior paternity or fertility treatments
• Childhood illnesses and development
• Medical illnesses, prior infections, and medications
• Prior surgeries or traumas

Exposure to potential gonadal toxins, such as heat, radiation, chemical solvents, pesticides or smoking/marijuana use.

A thorough physical exam will also be done to assess body type, hair distribution, breast development, and the external genitalia. Your doctor will pay close attention to the size and consistency of the testicles and the structures within the spermatic cords: the vasa deferentia (two ducts that carry sperm away from the testicles to prepare for ejaculation) and possible varicoceles (enlargement of the veins in the scrotum).

Semen Studies

A semen analysis is the most important laboratory evaluation for a man with infertility and in many circumstances is performed prior to the initial consultation.

A semen analysis provides information on:

• Volume of the ejaculate
• Sperm concentration and motility
• Appearance of sperm under the microscope (morphology)

Men may have significant variations in their semen parameters, so it is important to have at least two semen analyses before any definitive diagnosis is made. Furthermore, there can be laboratory variations in how semen analyses are performed, so your doctor may ask you to perform additional tests to confirm results.

Specialized tests can be performed on semen and might be recommended by your physician under certain circumstances. These tests include assessments of leukocytes, anti-sperm antibodies, reactive oxygen species, and sperm DNA integrity. If the ejaculate volume is low, we will likely perform a post-ejaculate urinalysis to evaluate for possible retrograde ejaculation.

To prepare for your semen analysis, you must abstain from ejaculating for two to five days and ensure you are not exposing yourself to lubricants that may be toxic to sperm and ensure you don’t have illness or febrile.  

Endocrine Evaluation

The testes produce the male hormones testosterone and its metabolites and mature sperm in response to specific hormonal signals from the brain. Hormonal abnormalities can contribute to poor sperm production (spermatogenesis) and may be correctable in certain circumstances.

The endocrine test includes measurements of serum testosterone, follicle stimulating hormone, luteinizing hormone, prolactin, and, occasionally, estradiol. Not all men will need to undergo an endocrine evaluation.

Ultrasonography

Ultrasound of the scrotum and its contents may be performed when physical exam findings are unclear.

Transrectal ultrasound will likely be performed when the ejaculate volume is low without any other explanation. The purpose of the transrectal ultrasound is to visualize the prostate, seminal vesicles, and ejaculatory ducts to evaluate for an ejaculatory duct obstruction.

Genetic Testing

Genetic abnormalities may cause infertility by affecting sperm production or sperm transport. The results of genetic testing may not only direct the approach to infertility therapy but can also provide information on the presence of abnormalities that may impact future children.

The most commonly known genetic factors that contribute to male infertility are:

• Y-chromosomal microdeletions that result in immotile sperm or low sperm count
• Klinefelter’s syndrome, an abnormality in the number of chromosomes that results in poor testicular function
• Cystic fibrosis gene mutations that result in congenital absence of the vas deferens (CBAVD)

Our reproductive genetics team will help counsel you through genetic testing. Due to advancements in technology, we offer virtual or in-person genetic consultations.

Other Diagnostic Tests

Our team also offers advanced diagnostic tests for men with severe oligospermia or azoospermia (very low or no sperm counts) and offers testicular biopsies or fine-needle aspiration testicular sperm mapping (FNA testis mapping) to evaluate underlying spermatogenesis, allowing for precise and accurate surgical sperm retrievals. This procedure is safe and done in the outpatient setting with local anesthetic or under sedation.

Treatment

Once a diagnosis is complete, there are three approaches to treating male infertility.

Medical therapy is sometimes an option to reverse or improve certain types of inflammation or hormone deficiency.

Surgery may be recommended to treat problems with the male anatomy, such as ductal obstruction (from vasectomy or ejaculatory duct obstruction) or varicocele.

If neither medical nor surgical therapy is appropriate, your doctor may recommend using assisted reproductive technologies. Even in cases where no sperm are found in the ejaculate, sperm may be retrieved from the testicle using minimally invasive techniques. Once sperm is retrieved, pregnancy is possible using intracytoplasmic sperm injection (ICSI).