Male Factor Infertility

Infertility is not solely a female problem. Male infertility factors are responsible for 40-50% of infertility. Just as female infertility raises emotional issues related to femininity and motherhood, men also experience perceived threats to their masculinity and fatherhood. Assuming the difficulty is with the female partner, often the woman will be evaluated and treated and the couple may still be unsuccessful. This causes increased frustration and anxiety. At Virginia Fertility Associates we recommend that both partners be evaluated.

What is Male Factor Infertility?

It is the inability to successfully fertilize a woman’s egg. It may be due to structural abnormalities, sperm production disorders, ejaculatory problems, or sperm genetic disorders. It can be caused by scarring to the vas deferens that blocks the sperm ducts, which can be the result of infection or a previous vasectomy, and/or hormonal factors.

90% of the time it is due to sperm abnormalities. Sperm abnormalities include abnormal shape and size of sperm, low sperm count, and low motility. About 5% of the time the inability to fertilize an egg is due to issues related to intercourse, such as erectile dysfunction, premature ejaculation, retrograde ejaculation or psychological issues that cause impotence.

Risk factors for Male Factor infertility

  • Varicoceles, enlarged veins in the testicles similar to varicose veins, increase testicular temperature which can affect sperm quality.
  • Aging causes men to have reduced sperm counts, and genetic quality declines.
  • Sexually transmitted diseases can scar the male reproductive system and impair sperm function.
  • Some medical conditions affect sperm including injury, diabetes, HIV and thyroid disease. Urinary tract infections and prostatitis can alter sperm mobility.
  • Benign Prostatic Hyperplastic (BPH) and prostate cancer can affect fertility.
  • Cancer treatment or exposure to radiation and chemotherapy, some medications and other toxins can interfere with fertility.
  • Sometimes a man can develop antibodies to his own sperm due to testicular trauma, infection or previous surgery. Intrauterine insemination can solve the problem.
  • Testosterone therapy can shut down production of the hormones necessary for sperm production.
  • Smoking is a major factor in reducing sperm quality in adult men. Smoking affects semen volume, sperm count, motility and/or morphology.

The good news is that there are many treatments available to help these couples have a child.

The Fertility Evaluation

One of the first steps in any fertility evaluation is a thorough history of the male partner and a detailed semen analysis. Sometimes more specific tests on the structure and function of the sperm will be necessary. This is called a semen analysis which evaluates semen volume and composition, sperm count, sperm motility and morphology (shape and size). If a man cannot produce a sample, or the sample contains no sperm, there are additional procedures to enable examination and use of the sperm.

Often the man will be evaluated by a urologist to look for anatomical causes for the abnormal sperm parameters. Blood work to evaluate the presence of endocrine disorders or chromosomal abnormalities may also be indicated.

Even when there is a male factor issue, it doesn’t mean that this is the single or sole cause of the couple’s inability to conceive. The female partner must also be evaluated as well, even when a male factor is present.

Treatment options

Treatment depends on the cause of the male factor causing infertility.

  • Blood tests can reveal low testosterone or other hormones, and medications are available to treat these disorders.
  • A variocele can be surgically repaired with a minor outpatient procedure.
  • Infections can be treated with antibiotics, but scarring that blocks the tubes that carry the sperm can be repaired or unblocked. When not recommended, the surgeon can harvest the sperm for use in advanced reproductive techniques.
  • Undescended testicles can cause testicular failure or the inability to make sperm in adequate numbers. Sperm harvesting can overcome this issue.
  • Common drugs can impair sperm production or function, and affect ejaculation. The offending drug can be changed.
  • Men with a previous vasectomy who desire to father a child can have a surgical vasectomy reversal.

At Virginia Fertility Associates, we are passionate about your care.