Understanding Male Infertility

WHAT IS MALE INFERTILITY?

Male infertility, or male factor infertility, refers to any health condition that reduces a man's ability to conceive with a female partner.

In heterosexual couples, male infertility accounts for roughly half of all infertility cases. Diagnosis is typically made by a urologist, a specialist in the male reproductive system and urinary tract.

Understanding and addressing male infertility is essential for couples facing challenges with conception, as it plays a significant role in many fertility journeys.

Male fertility refers to whether a person’s sperm can successfully fertilize an egg, given the opportunity. In order to do so, a person must produce enough healthy, functional and motile sperm, and the sperm must successfully travel through tubes from the testicles into the semen. 

Complications in any of these processes can affect fertility. Male infertility often involves problems with how the testicles work, but roughly half of the time, the cause is unexplained. 

Common causes of male infertility include:

✓ Erectile dysfunction
✓ Ejaculation problems (no sperm or premature)
✓ No sperm in ejaculated fluid (known as azoospermia)
✓ Affects about 10-15% of men with infertility
✓ Enlarged veins in the scrotum (known as varicocele)
✓ Physical trauma to the testes
✓ Undescended testicles
✓ Chemotherapy
✓ Hormone imbalances
✓ Age
✓ Genetics
✓ Obesity
✓ Diet and nutrition
✓ Stress
✓ STIs
✓ Smoking
✓ Substance use
✓ Anabolic steroids/testosterone use

Male fertility testing is necessary to diagnose male infertility and to determine the best treatment options. Male fertility testing almost always requires a semen sample analysis in which a person masturbates into a sterilized cup at home or a collection center, and a lab specialist analyzes the sample within two hours of collection.

Testing for male infertility could also include a blood test to check for hormone imbalances and genetic conditions. 

Here are some characteristics that a typical semen analysis will report on:

Concentration

We expect the sperm count in a semen sample to be between 15 million to 300 million (or more) per milliliter. If this number is low it could indicate blockages preventing sperm flow or that the testicles are not producing sperm properly, making it more difficult to conceive. 

Shape (Morphology)

We are looking for sperm with one head and one tail. While it’s typical for most sperm in a sample to be abnormal in shape, when less than 4% are normal it can contribute to infertility. 

Activity (Motility)

More than 42% of sperm in a semen sample should have normal swimming movement. If enough sperm aren’t swimming as expected, it will impact the likelihood of fertilization.

Total Motile Sperm Count (TMC)

TMC is one of the best predictors of male fertility. This value is the sperm concentration multiplied by volume multiplied by motility. 

pH

Normal pH levels in a semen sample are between 7.2 and 7.8. When semen pH is more basic (with a pH higher than 8.0) it can indicate infection. More acidic semen (a pH lower than 7.0) may indicate a contaminated sample or blocked ejaculatory ducts.

Volume

The expected volume of a semen sample is between 1.5 - 5 milliliters (mL). A lower volume typically correlates to less sperm available to fertilize an egg. Volumes below 1.5 mL indicate blockage(s) or problems with the seminal vesicles or prostate.

Liquefaction

While semen is initially viscous, its ability to liquefy in a short amount of time helps sperm to move. If semen does not liquefy in 15 to 30 minutes, fertility could be affected.

If male fertility test results are abnormal, infertility treatment options are available and you may be referred to a specialized reproductive urologist for further evaluation and treatment. Depending on the family and fertility goals, recommended treatments may include:

✓ Intrauterine Insemination (IUI): A procedure in which sperm is placed directly into the uterus during peak fertility, which may be facilitated by medications and/or monitoring.

✓ In Vitro Fertilization (IVF): A form of assisted conception where a person's ovaries are stimulated with medication to develop many mature eggs. The eggs are retrieved under anesthesia and fertilized in the laboratory. Over the course of several days, some will grow into embryos viable for transfer to the person's uterus in hopes of becoming a pregnancy.

✓ Intracytoplasmic Sperm Injection (ICSI): A procedure in which a doctor injects a single sperm into one mature egg. Doctors typically recommend this treatment when male infertility is a factor or after unsuccessful IVF treatment(s).

✓ Varicocele Surgery: An outpatient surgical procedure to address enlarged veins in the scrotum. The surgery redirects blood flow to circulate correctly out of the scrotum.

✓ Percutaneous Epididymal Sperm Aspiration (PESA): An outpatient surgical procedure to collect sperm for Intra Cytoplasmic Sperm Injection (ICSI). Doctors typically recommend PESA to people with no sperm in their semen (azoospermia) due to a blockage issue.

✓ Microsurgical Epididymal Sperm Aspiration (MESA): A microsurgical procedure to extract sperm from epididymal tissue. Doctors typically recommend MESA to people with a normal sperm count but with a blockage that prevents sperm flow to the semen.

✓ Testicular Sperm Extraction (TESE) or Testicular Biopsy: A procedure in which a doctor makes a small surgical incision in the testicle to collect tissue for analysis and sperm extraction.

✓ Microsurgical Testicular Sperm Extraction (microTESE): A procedure in which a doctor performs an extensive testicular dissection under a microscope to identify rare areas of sperm production and extract rare sperm in men with no sperm in their semen (azoospermia).

✓ Medical Therapy: Certain conditions may be improved by hormone therapy or use of special supplements and antioxidants to improve sperm numbers or quality.