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Male Infertility

Infertility can affect men as well as women. For couples trying to conceive a child, the issue of infertility needs to be explored from the male side as well as the female side. Is the man not producing enough sperm? Is there an issue with the “quality” of the sperm? Are the sperm underdeveloped? Are they abnormally-shaped? Is a varicocele (dilated scrotal veins) affecting the sperm’s ability to transport to their desired location? Is sperm pushing backwards into the bladder as in retrograde ejaculation? We can investigate the issues from the male perspective and either find the source of the problem or rule out the male as having physical problems relating to conception.

Infertility is medically defined as inability to conceive after 1 year of frequent unprotected sex. Male infertility is often the cause or a significant contributing factor. The sperm of the male needs to be produced properly to be mature and healthy and must be produced in adequate numbers. It then needs to travel to the female and unite with the egg. Difficulty at any point in this process may result in infertility.

Causes of sperm malfunction include:

  • Improperly made sperm that do not mature properly, may not move properly, may be in insufficient numbers, or may not be produced at all.
  • Varicoceles or swollen scrotal veins may impede sperm growth and numbers by making the testicles too warm for sperm to successfully form and travel.
  • Retrograde ejaculation is when the muscles of the bladder insufficiently close during orgasm causing the sperm to travel backwards into the bladder and not be ejaculated from the penis.
  • Immunologic infertility is an autoimmune condition in which abnormal antibodies are produced by the male that attack his own sperm making them nonviable.
  • Obstruction is where the “road” the sperm must travel has been blocked either by a medical disorder like prior surgery, tumors, or undescended testicles (a fetal developmental abnormality) or by choice as in a vasectomy.
  • Hormonal imbalances, chromosomal defects, radiation, heavy metals, and some medications may also result in infertility.
  • Drug use (anabolic steroids, cocaine, marijuana), alcohol, tobacco, and obesity may significantly impair fertility.

Diagnostic testing by your AUCNY urologist can help determine the specific cause for the male infertility:

  • Detailed history and physical examination – requesting details on symptoms, personal and family medical history, social history including smoking habits, physical examination with special emphasis on the bladder area including rectal/pelvic exam and blood testing
  • Urine test – to check for retrograde sperm ejaculation
  • Semen analysis – a semen sample is analyzed to measure the number of sperm present to determine if their numbers are adequate and to observe the sperm’s shape and movement to determine their health. Usually, multiple samples are tested as results for individual samples may vary.
  • Imaging procedures – scrotal or transrectal ultrasound to check for blockages which might restrict the travel of the sperm
  • Other tests such as hormone testing, genetic testing, biopsy of the testicles, or specialized sperm function tests may be ordered

Treatment Options

Male infertility treatment is specialized depending on the specific cause of the infertility. Your AUCNY urologist will discuss all of the therapy options including:

  • Prescription medications that may be helpful in some forms of male infertility
  • Surgical procedures that may repair blockages or anatomical problems
  • Assisted reproductive techniques (ART) such as intrauterine insemination where the urologist places the sperm into the female’s uterus or in vitro fertilization where the sperm and egg are joined in a lab Petri dish are available.

In rare cases, when male fertility problems cannot be resolved, other options may include using donor sperm or adoption.

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