Male infertility can prevent couples from conceiving children.

The inability to procreate affects men and women, both physically and emotionally. While only a small percentage of men experience fertility difficulties, male infertility contributes to as much as 50% of fertility issues for couples.

When men experience male infertility, they may feel a loss of virility, low self-esteem, or even depression. Fortunately, there are several identifiable causes contributing to male infertility, as well as ways to address them. A first step to addressing the issue, is understanding what may be causing it.

What causes male infertility?

In the United States, countless of men and women are affected by infertility. When a couple is having trouble conceiving, it could be linked to one of the following factors:

• Sperm – low sperm count; poor quality
• Testicular conditions – varicocele, hydrocele, testicular cancer
• Advanced age
• Genetics
• Hormonal deficiencies
• Trauma or injury in the groin
• Prescription medications
• Recreational drug use
• Medical conditions such as diabetes or autoimmune disorders

Evaluation for male infertility

When diagnosing infertility, both partners should be evaluated; preferably at the same time. Women often seek an infertility evaluation from their obstetrician or gynecologist. Men can be evaluated by a urologist who specializes in male reproduction. A thorough assessment of male infertility will include a semen analysis, a complete personal and family history, and an in-office physical examination.

In men, the testes produce sperm that contain genetic material to fertilize the female oocyte (egg) which initiates pregnancy. Each step in sperm production and transport is important to fertilize an egg. Any alteration in this process may result in male infertility.

Diagnosing male infertility

The following is a list of diagnostic considerations when assessing male infertility:

• Age – The age of man and his partner.
• Previous fertility issues with either partner.
• Contributing events or health issues – Possible events that can affect fertility such as mumps, orchitis (inflammation of the testes), history of prior testicular trauma, or a malignancy.
• Environmental factors – Alcohol or tobacco use, past history of anabolic steroids, frequent use of a hot tub, and type of underwear worn.
• Prescription medications.
• Recreational drugs use.
• Genetic factors – Men who have cystic fibrosis (CF), are carriers of the gene, or have cystic fibrosis in their family, may have a genetic connection to infertility. The CF gene can hinder the development of the vas deferens.
• History of ambiguous genitalia – Genitalia that is not obviously male or female.
• Surgical history – Surgery to the genitourinary tract including orchiopexy, herniorrhaphy, or any transurethral surgery.
• Coital history – Length of time the couple has been trying to conceive, timing of intercourse, and the use of any lubricants that could be spermicidal (destroys sperm).
• History of a recent febrile illness – This illness would include a fever or rise in body temperature that could affect conception.

Physical examination steps

When visiting a urologist, a complete physical exam will be performed. The evaluation will include:

• Assessment of sexual maturity, i.e., male hair growth pattern.
• Investigation of inguinal (groin) or scrotal incisions.
• Evaluation of penis.
• Examination of testicles for consistency and size.
• Hand evaluation of the epididymis – An irregular eididymis may indicate infection or an obstruction.
• Hand evaluation of the vas deferens.
• Evaluation for hernias in the groin.
• Examination of the scrotum for possible varicocele or hydrocele.
• Examination of the prostate to rule-out prostatitis.
• Examination to rule out diseases that may impair testicular function.
• Vasography – An x-ray that looks for blockage of the vas deferens.
• Possible testicular biopsy or needle aspiration.
• Genetic testing.
• Semen analysis.
• Blood work to include a hormonal evaluation: FSH (follicle stimulating hormone), LH (luteinizing hormone), testosterone, and prolactin.

If you have been unsuccessful in conceiving a child with your partner, we recommend that you schedule an appointment with one of our urologists specializing in male reproduction.