Male Factor Infertility
What is Infertility?
Infertility is defined as the inability of a couple to conceive after 12 months of unprotected and timed (following ovulation) intercourse. 15% of couples struggle with infertility. A male factor is solely responsible for infertility in 20% of these couple and is a contributor to an additional 30%. Thus, male-factor infertility is significant and deserves to be evaluated.
What Testing Will I Need to Undergo?
Semen analysis is the standard first step in evaluation of male reproductive potential. This test evaluates the characteristics of the sample (volume, pH), sperm parameters (concentration, motility) and the presence of other cells. It should be noted that we often recommend more than one semen analysis because semen samples can vary. Given hormonal abnormalities may contribute to male factor infertility, other testing may include an endocrine evaluation. Impaired semen parameters, impaired sexual function, low sex drive or other clinical findings suggestive of a hormonal abnormality may necessitate an endocrine evaluation. The evaluation involves checking blood levels of hormones that are involved in male sexual function and reproduction. Imaging is less often required but may include ultrasound of the testes and spermatic.
Additionally, transrectal ultrasound is occasionally used to evaluate the prostate, seminal vesicles and ejaculatory ducts. In patients with low semen volume, a post-ejaculatory urinalysis may be indicated to assess for sperm in the urine. Some forms of male factor infertility may be inherited. Genetic testing is indicated in men with no sperm (also called Azoospermia) or very low sperm counts seen in the ejaculate. The genetic tests offered are a Karyotype, which evaluates a patient’s chromosome composition, and Y-chromosome microdeletion, which tests specific genetic information on the Y-chromosome.
What Can I Do to Improve Fertility Potential?
There are lifestyle factors and environmental agents that can negatively affect sperm. Use of tobacco, marijuana, recreational drugs, excessive alcohol intake, anabolic steroids and exogenous testosterone replacement therapy should be avoided. Repeated exposure to chemical solvents, heavy metals or heat (fever, frequent hot tubs or saunas) can be harmful to sperm. Anything that improves your overall health can improve your sperm health. For overweight men, weight loss may be recommended. Reduce or avoid the aforementioned exposures.
Additionally, exercise and dietary changes (increase fruits/vegetable intake and decrease processed foods) may be beneficial. There is some evidence that male fertility may be improved with over-the-counter vitamins or supplements, though the data is inconclusive. Given supplements’ low cost and few side effects, antioxidants and multivitamins are frequently recommended to men presentingwith subfertility. Some commonly used supplements include a men’s multivitamin, L-Carnitine, Coenzyme Q10, Zinc and Folic Acid. It is important to note that supplements are not regulated by the FDA and, thus, may carry unknown side effects. If taking vitamins/supplements, be sure not to overlap ingredients, as too much of a specific nutrient can be harmful.
What is the Role of the Urologist in Male Factor Infertility?
Male factor infertility can be due to a variety of conditions, many of which can be identified and treated, though sometimes the cause is idiopathic (or unknown). The urologist’s role is to evaluate the male partner and then identify and treat correctable conditions contributing to the couple’s infertility. In managing the male partner, a couple may be able to naturally conceive or may need other assisted reproductive techniques such as intrauterine insemination or in vitro fertilization through a reproductive endocrinologist (female infertility specialist). A male infertility specialist works with the female infertility specialist to provide comprehensive care to the couple struggling with infertility.
Additionally, since there are medical conditions associated with male factor infertility, it is important for men to establish a relationship with a urologist to have a full evaluation of their general health. It is a privilege and tremendous responsibility to care for you in your fertility journey.