Primary / Secondary Male Infertility
Source: Urology Health, American Urological Association
Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant.
About 13 out of 100 couples can’t get pregnant with unprotected sex. There are many causes for infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery.
What Happens Under Normal Conditions?
The man’s body makes tiny cells called sperm. During sex, ejaculation normally delivers the sperm into the woman’s body.
The male reproductive system makes, stores, and transports sperm. Chemicals in your body called hormones control this. Sperm and male sex hormone (testosterone) are made in the 2 testicles. The testicles are in the scrotum, a sac of skin below the penis. When the sperm leave the testicles, they go into a tube behind each testicle. This tube is called the epididymis.
Just before ejaculation, the sperm go from the epididymis into another set of tubes. These tubes are called the vas deferens. Each vas deferens leads from the epididymis to behind your bladder in the pelvis. There each vas deferens joins the ejaculatory duct from the seminal vesicle. When you ejaculate, the sperm mix with fluid from the prostate and seminal vesicles. This forms semen. Semen then travels through the urethra and out of the penis.
Male fertility depends on your body making normal sperm and delivering them. The sperm go into the female partner’s vagina. The sperm travel through her cervix into her uterus to her fallopian tubes. There, if a sperm and egg meet, fertilization happens.
The system only works when genes, hormone levels and environmental conditions are right.
Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility.These are the main causes of male infertility:
- Sperm Disorders
- Retrograde Ejaculation
- Immunonologic Infertility
Causes of male fertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis starts with a full history and physical exam. Your health care provider may also want to do blood work and semen tests.
History and Physical Exam
Your health care provider will take your health and surgical histories. Your provider will want to know about anything that might lower your fertility. These might include defects in your reproductive system, low hormone levels, sickness or accidents.
Your provider will ask about childhood illnesses, current health problems, or medications that might harm sperm production. Such things as mumps, diabetes and steroids may affect fertility. Your provider will also ask about your use of alcohol, tobacco, and other recreational drugs. He or she will ask if you’ve been exposed to radiation, heavy metals or pesticides. Heavy metals are an exposure issue (e.g. mercury, lead arsenic). These can affect fertility.
Your health care provider will learn how your body works during sex. He or she will want to know about you and your partner’s efforts to get pregnant. For example, your healthcare provider may ask if you’ve had trouble with erections.
The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor will look for varicoceles. They can be found with a physical exam.
Semen analysis is a routine lab test. It helps show the level of sperm production and whether sperm are functioning well (e.g., are moving, measured as sperm motility). The test is most often done at least twice, if sperm numbers are abnormal. Semen is collected by having you masturbate into a sterile cup. Your health care provider will study your sperm volume, count, concentration, movement (“motility”), and structure.
Your health care provider may order a transrectal ultrasound. A probe is placed in the rectum. It beams sound waves to the nearby ejaculatory ducts. The health care provider can see if structures such as the ejaculatory duct or seminal vesicles are poorly formed or blocked.
If a semen test shows a very low number of sperm or no sperm you may need a testicular biopsy. This test can be done with general or local anesthesia. A small cut is made in the scrotum. A small piece of tissue from each testicle is removed and studied under a microscope. The biopsy serves 2 purposes. It helps find the cause of infertility and it can collect sperm for use in assisted reproduction (such as in vitro fertilization; IVF).
The health care provider may check your hormones. This is to learn how well your testicles make sperm. It can also rule out major health problems. For example, follicle-stimulating hormone (FSH) is the pituitary hormone that tells the testicles to make sperm. High levels may mean your pituitary gland is trying to get the testicles to make sperm, but they won’t.
Treatment depends on what’s causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex.The treatments below are broken into 3 categories:
- Non-surgical therapy for Male Infertility
- Surgical Therapy for Male Infertility