“Male factor” describes the male’s infertility problems that contribute to a couple’s trouble conceiving. According to the ASRM, approximately 40 percent of infertility cases can be attributed to male infertility, where the male partner is either the sole source of infertility, or part of the problem. Fertility is a team effort, and it is important that couples trying to conceive understand both partners play important roles.
The first step in evaluating male infertility is a semen analysis. The male partner gives a semen sample by masturbation, and the semen is tested for sperm numbers, movement, appearance and shape.
If abnormalities are found, more than one semen sample is analyzed, with the samples taken over several months. The doctor may order other tests be performed as well. While there are many causes for male factor infertility, in most cases the cause is not found. This can be frustrating for many couples, but in all but the most severe cases treatment is successful in achieving a pregnancy as long as the correct intervention is performed. The doctor may recommend intrauterine insemination (IUI – also called artificial insemination) or in vitro fertilization (IVF) procedures.
The conditions listed below are what most fertility specialists and urologists agree on as the major causes of infertility. These are diagnosed through semen analysis, physical exam, blood testing, or imaging techniques like ultrasound.
Sometimes men do not produce enough sperm due to hormonal problems or other unknown reasons. The cause and correct treatment to pursue are gathered from examination and hormonal testing. In general, there are no medications or surgical treatments that can correct the problem. Some men have a condition called varicocele, which is essentially a swollen vein in the testis. If the vein is tied off, there may be an improvement in sperm parameters and pregnancy rates may improve. It should be noted, however, that this approach is somewhat controversial.
Roughly 10 percent of men dealing with infertility produce sperm normally, but an obstruction in the genital tract blocks the sperm from traveling from the testis into the ejaculate. A common example is a man who has had a vasectomy in the past, but now wants children and is seeking to surgically reverse the procedure.
Other obstructions in the genital tract may be caused by the absence of the vas deferens – the duct that transports the sperm from the testicles to the penis. This issue is usually associated with cystic fibrosis. Infections can also block the sperm ducts, but surgery may allow normal ejaculation.
For normal sperm production, hormonal secretion from the hypothalamus, pituitary and testis that trigger sperm production must occur. These hormones must also work on the testicular tissue that performs actual sperm production. Abnormal hormones may inhibit the process.
About 10 percent of infertile males have hormone problems, leading to very low sperm counts. A doctor can investigate and sometime treat abnormal hormones in order to increase sperm production.
The testicles’ exposed position puts them at a higher risk of injury. An injury or even surgery may interfere with a testicle’s blood supply, thus reducing the growth and maturation of sperm. Trauma occasionally may cause the body to create antibodies against the sperm which also compromises their effectiveness in achieving a pregnancy.
Cryptorchidism describes the condition in boys born without their testicles fully descended from their scrotum, which needs to be correctly medically or surgically early in life. If left unattended, sperm production is often deficient after puberty.
Major medical conditions such as kidney failure, liver disease, cancer, and other cardiovascular illnesses may also adversely impact sperm production.