Male Factor Infertility Explained

Infertility is a journey that affects many couples, and understanding its causes can be the first step toward finding a solution. While fertility issues are often associated with a female partner, male factor infertility plays a significant role in about 20% of cases and contributes to an additional 40% of infertility cases. In this blog post, reproductive urologist Dr. Stephen Lazarou from Boston IVF provides insight into male infertility and the various steps toward diagnosis and treatment.

What is Male Factor Infertility?

Male infertility is most commonly diagnosed through an abnormal semen analysis, which looks at sperm count, motility (movement), and morphology (shape). However, even individuals with normal semen analyses may experience fertility issues due to a variety of underlying conditions. Some of these conditions can be reversed, while others, such as testicular injury or atrophy, are not.

When Should You Seek an Evaluation?

Straight couples should consider a male fertility evaluation if they have been trying to conceive for one year without success. However, certain risk factors may warrant an earlier assessment, such as:

• Undescended testes (when the testicles fail to fully descend into the scrotum during development).
• Cancer history (chemotherapy or radiation can affect fertility).
• Age-related factors (especially if the female partner is older).

It’s also important to note that individuals who have fathered children in the past may still experience secondary infertility due to newly acquired factors.

The Male Fertility Evaluation Process

A comprehensive male fertility evaluation involves several steps:

1. Medical and Reproductive History: This includes reviewing any childhood illnesses, developmental history, medications, systemic illnesses like diabetes, past surgeries (e.g., hernia or testicular surgeries), and history of infections.
2. Physical Examination: A thorough physical exam includes checking for:
   • Penis structure and any abnormalities (such as curvature).
   • Testicular size, shape, and consistency to identify conditions like testicular atrophy or injury.
   • Ductal structures, such as the vas deferens and epididymis, which are critical for sperm transport and storage.
   • Varicoceles (enlarged veins in the scrotum) that may affect sperm production.
   • Secondary sex characteristics such as body hair distribution and breast tissue to identify hormonal imbalances.
3. Semen Analysis: Typically, at least two semen analyses are conducted, as results can vary significantly. This test looks at sperm count, motility, and morphology to assess sperm quality.
4. Additional Testing: If the initial evaluation reveals abnormalities, further testing may be necessary, such as:
   • Hormonal evaluation to check for imbalances affecting fertility.
   • Ultrasound of the scrotum to examine the testicles and surrounding structures for abnormalities.
   • Genetic testing to identify conditions that could be passed on to offspring or underlying causes of infertility.

Treatment Options for Male Infertility

The good news is that many conditions affecting male fertility can be treated, and treatment can lead to conception through natural intercourse, if that is the goal. Some treatment options include:

• Surgical correction of varicoceles or blockages.
• Hormonal treatments to restore balance and improve sperm production.
• Lifestyle changes like quitting smoking, avoiding excessive heat exposure, or discontinuing testosterone supplements, which can negatively impact sperm production.

For individuals with more severe infertility, advanced reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be used. In some cases, sperm retrieval from the testicles or epididymis may be necessary for IVF.

The Role of Lifestyle in Male Fertility

Dr. Lazarou emphasizes that a healthy lifestyle is key to supporting male fertility. This includes:

• Maintaining a healthy weight and exercising regularly.
• Avoiding smoking and limiting alcohol consumption.
• Avoiding testosterone supplements, as they can severely impact sperm production.

Seeking Help for Male Infertility

Male infertility is a complex issue, but with proper diagnosis and treatment, many indidivuals can improve their fertility and achieve their dream of parenthood. If you’re struggling with fertility, it’s essential to get a thorough evaluation from a reproductive urologist, like Dr. Lazarou at Boston IVF, to understand the cause and explore your treatment options.