When couples have trouble conceiving, it's often assumed to be a "female" problem. But male factors may come into play in up to half of all infertile couples.
Most cases of male infertility occur when a man cannot produce or deliver fully-functioning sperm. Production of healthy sperm starts in the testicles. Next, the sperm move to a cord-like structure called the epididymis, where they mature. Once fully mature, the sperm are ready to be pushed out of the body through the urethra during ejaculation. The whole process takes several months.
Healthy sperm need the right conditions to develop properly. A healthy level of testosterone - the male hormone - must be present. Also, the temperature in the scrotum, which is the sac that holds the testicles, must be slightly lower than body temperature.
If you have been trying to conceive for at least 12 months without success, it is time to talk with your doctor. You might do this sooner if you know from the start you have a higher infertility risk. The causes could be prior health problems, family history, or age - usually about 35 and older.
The doctor will gather a broad personal history for both the man and the woman. The history should cover these issues:
- Medical - illnesses, diseases, infections, medications
- Surgical - procedures that could affect reproductive and urinary systems
- Sexual - performance, history of sexually transmitted diseases
- Social history - smoking, drinking, illicit drug use, leisure activities such as cycling
- Family history - reproductive, cancer, prostate, bladder, or genetic problems
Physical exam and semen analysis
The doctor will do a physical exam and order a semen analysis. The physical exam will focus mostly on the penis and testicles. The doctor will check for male sex traits, such as body hair and sexual development. He or she will also look for lesions, scars, or abnormalities of the scrotum.
Semen analysis is the key test to learn about male infertility. Semen is the fluid that carries, protects, and provides the energy for the sperm. Most men will need at least two semen analyses.
Sperm in the semen sample will be checked for amount, movement, appearance, and shape. Your doctor may use the terms volume, motility, and morphology. An abnormality of any of these could affect reproduction.
Other tests may be done to find out if:
- Enough sperm in the sample are alive
- Antibodies are attached that impair proper sperm motion
- The sperms' outer layers are broken
- Too many sperm are broken or have fragile DNA
What's causing the problem?
Male infertility usually falls into one of two areas: sperm production and/or sperm delivery. There are many problems that prevent sperm from forming, maturing, or fertilizing. Some causes can include:
- Varicoceles. These are abnormal enlargements of veins in the scrotum. They are present in about 40 percent of infertile men.
- Retrograde ejaculation. Semen pushes backward into the bladder and not out of the penis. This can be due to surgery, drugs, or nervous system diseases.
- Immunologic infertility. A man's own antibodies can attack his sperm and prevent movement or function.
- Obstruction. Repeated infections, prior surgery, and swelling can block sperm from passing normally.
- Genetics. Chromosome problems can affect fertility.
- Medication. Certain drugs can affect sperm growth, function, and ejaculation.
Once the cause of infertility is known, your doctor can start to address the problem. Surgery, drugs, and lifestyle changes can often help men with infertility problems make parenthood a happy reality.
Created on 07/30/2008
Updated on 06/03/2011
- American Society for Reproductive Medicine. Diagnostic testing for male factor infertility.
- American Urological Association. Management of male infertility.
- American Urological Association. Male infertility.