The inability to conceive a child can be stressful and frustrating, and although infertility affects almost 6.7 million couples in the United States (a staggering 10-11% of reproductive aged couples in the United States), it is highly treatable in many cases.
The highly specialized field of male fertility involves a wide range of medical, environmental, and lifestyle causes which also includes many very specific risk factors. However, now that the genetic causes of male infertility are more commonly diagnosed, and several male infertility treatments are readily available, couples having difficulty conceiving, or carrying to term, can often have success with the use of fertility medications.
Infertility is defined as a couples' inability to conceive a child even though they've had frequent, unprotected sexual intercourse for a year or longer.4 According to the Mayo Clinic, infertility results from exclusively male infertility factors about one-third of the time, exclusively female infertility factors about one-third of the time, and a combination of male and female factors or an undeterminable factor about one-third of the time.
As would be expected the main symptom of infertility (male or female) is the inability to conceive. Although there may be no other obvious symptoms, underlying problems such as hormonal imbalances, inherited disorders, or certain medical conditions in which the passage of sperm may result in telltale signs which include:
Prior to discussing the causes of infertility, let's examine the complex process of fertility from the male perspective. This process begins with properly functioning testicles, and the ability to produce testosterone as well as the supporting hormones which trigger and maintain sperm production. Once produced, delicate tubes transport sperm cells until they mix with semen and are ejaculated out of the penis. If the number of sperm in your semen (sperm count) is low, it decreases fertilization odds. Most authorities consider low sperm count to be fewer than 15 million sperm per milliliter of semen, or fewer than 39 million per ejaculate. In addition to production and volume, sperm cells must be shaped correctly and able to move freely. If the movement (motility) and shape (morphology) of your sperm is abnormal, it will experience difficulty reaching and penetrating the egg to complete fertilization.
Male infertility is most often due to three factors: 1) blockages that prevent the delivery of sperm; 2) low sperm count; and 3) misshapen or immobile sperm cells. However, because the process is so delicate, many related factors can also contribute to the overall problem including injuries, poor lifestyle habits, illnesses, and chronic health problems. More specifically, infertility causes are traditionally grouped into medical, environmental, and lifestyle categories among which are:
Health, Lifestyle, and Other Risk Factors:
The first step in addressing suspected infertility is to visit your family doctor or a general practitioner, after which you will likely be referred to a fertility specialist who will perform an extensive evaluation, which includes a lot of routine present and past medical information. Although the scheduling receptionist may or may not request that you to do so, you can gather much of the necessary data prior to your visit, such as:
In most cases, both partners are tested and may undergo a number of varied and gender specific tests to determine the cause of infertility. Such infertility tests can be expensive and may not be covered by insurance, so find out what your medical plan covers ahead of time. Testing usually involves a general physical examination of your genitals, followed by questions that could affect fertility about: surgeries and injuries; chronic health problems and illnesses; sexual habits; sexual development during puberty; and possibly inherited conditions.
Also standard during testing is the semen analysis wherein you'll submit semen at the doctor's office, which is sent to a laboratory to measure the number of sperm present, look for abnormalities in the morphology and motility, and signs of infections. Since sperm counts fluctuate from one specimen to the next, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
If deemed appropriate, your doctor may recommend additional tests to help identify the cause of your infertility which may include: testicular biopsy; anti-sperm antibody tests; specialized sperm function tests; scrotal or transrectal ultrasounds; hormone testing; post-ejaculation urinalysis; and/or genetic tests.
Fertility is improved by either correcting an underlying problem, though sometimes an exact cause of infertility can't be identified, or by trying treatments that may be helpful which may include: