Male Infertility

Male infertility is any condition in which the man adversely affects the chances of initiating a pregnancy with his female partner. Most commonly, these problems arise when the man is unable to produce or deliver fully-functioning sperm. Male infertility is a significant factor in about 40% of couples who have infertility problems.

Causes

Common factors in male infertility are:

• Sperm disorders. Sperm may be underdeveloped, abnormally shaped, or unable to move properly. They may also be produced in abnormally low numbers or seemingly not at all. (Sperm disorders are the most common problems of male infertility.)
• Varicoceles. Dilated scrotal veins impair sperm development by preventing proper drainage of blood.
• Retrograde ejaculation. Occurs when semen pushes back into the bladder instead of out of the penis due to a failure of nerves and muscles in the bladder neck.
• Immunologic infertility. Antibodies attack sperm and prevent their normal movement and functioning. The causes for this may include testicular trauma, testicular infection, large varicoceles, or testicular surgery.
• Obstruction. Repeated infections, prior surgery, inflammation, or development problems can cause obstructions that block sperm from its normal passage.
• Hormones. Low levels of hormones produced by the pituitary glands can cause poor sperm development.
• Genetics. 
• Certain medications.

Which Males are More Likely to Have Infertility?

Some males are more likely than others to experience infertility. You might be more likely if:

• You are overweight or obese.
• You’re age 40 or older.
• You’ve been exposed to radiation.
• You’ve been exposed to environmental toxins including lead, calcium, pesticides, or mercury.
• You use tobacco, marijuana, or alcohol.
• You’re taking some medications including cyproterone, flutamide, spironolactone, bicalutamide, cimetidine, or ketoconazole.
• You’re around the heat that raises the temperature of your testes. Those who frequently use a sauna, hot tub, or wheelchair might experience this.
• You have a history of undescended testicle(s).
• You have a history of varicoceles, which are widened veins in your scrotum.

Diagnosis

A complete history and physical exam are typically followed by:

• Blood work 
• Semen analysis. Used to assess factors such as volume, count, concentration, movement, and structure of spermatozoa, that help or hinder conception.

Other tests may include:

• Transrectal ultrasound. Used to determine if your ejaculatory ducts are either poorly developed or obstructed with cysts, calcifications, or other blockages.
• Testicular biopsy. Used when a semen analysis shows low or no sperm to determine the cause of infertility.
• Hormonal profiles. Used to discover the sperm-producing ability of your testicles and to rule out serious conditions.
• Genetic testing. Used to identify specific obstacles to fertility and problems with sperm.

How is male infertility treated?

With modern technology and methods, the number of treatment options for male infertility has expanded. Depending on the cause of infertility, treatments may include:

• Medications-Hormone therapy to increase the number of sperm.
• Lifestyle changes:
  • Maintain a body weight that’s healthy for you.
  • Stop smoking.
  • Stop drinking.
  • Stop using marijuana.
  • Stop any recreational drug use.
• Surgeries:
  • Vasectomy Reversal: This common procedure is an outpatient surgery. The surgeon reconnects your vas deferens which is the tube in the scrotum through which your sperm passes. Viewing the vas deferens through a high-power surgical microscope, the surgeon carefully sews the ends back together.
  • Vasoepididymostomy: Blockages in your vas deferens are repaired with a similar technique. Your vas deferens is surgically split, the blockage is removed and the ends of the tube are reconnected. When the original vasectomy was performed many years previously, an additional blockage may have formed in the epididymis, the coiled tube that lies against your testicle where sperm cells mature. Blockage at the epididymis also can occur due to infection or injury. Whatever the cause, your surgeon will fix the problem by bypassing the blockage in the epididymis.
  • Sperm Retrieval: In some severe cases, a biopsy of the testicle is required to find sperm.
  • Intracytoplasmic sperm injection: Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection (ICSI) has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile males have the potential to conceive their own genetic child.

If you are struggling with infertility we encourage you to call our office. Infertility can be a particularly hard condition to experience and we at ZUrology understand the sensitive nature of infertility. We are here to support you however we can!