In the world of fertility, it’s often forgotten in casual conversations that it does, in fact, take two to tango (and to make a baby.) It’s normally women who get asked those intrusive questions about baby making, and who are the first to worry and think something is when the process of baby making isn’t working as they’d hoped. Yet male factor infertility, which is often less talked about, is a big part of the process.
In fact, “Male infertility is present in 15% of all men and 50% of all infertility cases involve a male factor—30% of the time it is the sole cause and 20% of the time there are issues on the male and the female side,” says James M. Hotaling, MD, MS, FECSM of Reproductive Medicine Associates of New Jersey (RMANJ).
Male fertility problems typically fall into the categories of sperm production (not making enough or even not making any at all), “plumbing problems” (where there is a blockage, like in after a vasectomy), a hormonal problem, or more uncommonly a genetic factor. Problems can also stem from chemical exposure or surgical history.
If a doctor suspects a male factor is contributing to infertility, the will likely perform diagnostic tests. First is usually a semen analysis. “A semen analysis where a sperm sample is examined under the microscope is the typical test that is ordered initially. This usually needs to be repeated at least once, as the results vary a fair amount from sample to sample,” says Dr. Hotaling. He adds that most infertile men should also, “undergo hormone testing to assess their levels of testosterone and other fertility hormones.”
In regard to other tests, sometimes a doctor will perform an ultrasound of the scrotum to rule out conditions like varicoceles or dilated veins in the testicles, and other more advanced tests can also be performed.
Luckily, male infertility is largely treatable. In fact, Dr. Hotaling says, “Nearly all causes of male infertility are treatable.” But how?
He explains, “We typically try to improve diet and lifestyle, optimize hormones and, where indicated, can often do a surgical procedure with an operating microscope to optimize sperm production, find sperm when very low amounts are being made or relieve a blockage, such as in a vasectomy reversal. We can also do procedures to obtain sperm for in vitro fertilization (IVF).”
When to Seek Help
Dr. Hotaling notes that all infertile men should have an evaluation by a reproductive endocrinologist, a urologist who has done extra training to take care of infertile men. He says, couples should seek treatment, “when they have been trying for 1 year, or 6 months if the woman is over 25 or when the issue is causing them significant stress.” Men should see a reproductive urologist, and females should seek a reproductive endocrinologist (REI). He adds, “in combination with our female infertility colleagues, we can help everyone become parents.”