Understanding Infertility

Infertility in Males

Infertility is related to the male 50% of the time and can be due to a low sperm count, low number of moving sperm or abnormally shaped sperm, all of which can make it difficult to fertilize the egg. The screening test for male factor infertility is semen analysis, which is typically obtained by masturbation into a sterile cup. The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains.

Some of the things that are measured are:

  • How much semen a man produces (volume)
  • The total number of sperm in the semen sample (total count)
  • The number of sperm in each milliliter of semen (concentration)
  • The percentage of sperm that are moving (motility)
  • If the sperm are the right shape or not (morphology)

The analysis can also detect if there is an infection in the male reproductive system.

If there is an abnormal semen analysis, further evaluation of the male is typically performed and may include a complete history and physical, as well as several tests to try to find the cause. A hormonal evaluation may be performed to assess the levels of hormones that are important in the male reproductive system. These include testosterone and follicle stimulating hormone. These hormones are involved in sperm production and in normal sex drive. Other hormone levels may be performed including luteinizing hormone, estradiol and prolactin.

If the sperm count is very low or there are no sperm, genetic tests may be recommended including a chromosome analysis or Y chromosome deletion testing. Complete absence of sperm may be related to a cystic fibrosis mutation, which can be diagnosed with a blood test. In some cases of complete absence of sperm, a testicular biopsy may be performed to help identify the cause.

Treatment of male factor infertility depends on the cause and severity of the problem. Some may be treated medically with hormonal treatments such as clomiphene citrate to stimulate sperm production. Surgical removal of a varicocele (swollen vein next to the testicle) may be indicated in some cases.

Treatment using IUI (intrauterine insemination) may be performed when there is a mildly reduced sperm count. With more severe male factor, IVF with ICSI (intracytoplasmic sperm injection) may be necessary.

We work closely with several reproductive urologists in both New York in Connecticut who are skilled in all aspects of male reproductive endocrinology and microsurgical sperm retrieval techniques.