Approach to Male Infertility

Infertility in a couple is defined as an inability to achieve conception despite one year of frequent, unprotected intercourse. Many infertile couples have more than one cause of infertility, so it’s important that both partners get full medical examinations to narrow the causes of infertility down. Usually, a number of tests are required to determine the cause of infertility. In some cases, a cause is never identified.

Male infertility can be categorized into four main areas:

  • Endocrine and systemic disorders (causes are related to secondary hypogonadism) – 2 to 5 percent.
  • Primary testicular defects in spermatogenesis – 65 to 80 percent, of which the majority have idiopathic dysspermatogenesis, an isolated defect in spermatogenesis without an identifiable cause.
  • Sperm transport disorders – 5 percent.
  • Idiopathic male infertility – 10 to 20 percent.

Interestingly, it can be difficult to detect male infertility, as the main sign of male infertility is the inability to conceive a child.

In some cases, underlying problems such as an inherited disorder, hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm can cause signs and symptoms. These may notice include:

Problems with sexual function — for example, difficulty with ejaculation or low volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction). Pain, swelling or a lump in the testicle area. Abnormal breast growth (gynecomastia). Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality.

A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

Diagnosing male infertility problems usually involves:

  1. General physical examination and medical history: This includes a genital examination and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. A detailed history about your sexual habits and sexual development during puberty will be taken.
  2. Semen analysis: Semen samples can be obtained in a couple of different ways. Usually, you provide a sample by masturbating and ejaculating into a special container at the doctor’s office.

The semen sample is sent to a laboratory to measure the number of sperm present and identify any abnormalities in the shape (morphology) and movement (motility) of the sperm. They can also rule out any infections at this point.

If investigations find that your sperm analysis/cytology is normal, then it is highly recommended that your female partner to be investigated for infertility.

Additionally, hormonal investigations may be needed to measure testosterone levels, LH &FSH, and estrogen levels to rule out hormonal deficiencies.


The main goal of male infertility treatment is to identify the cause and create a pregnancy. Ideally, the cause of the infertility is reversible and then conception can result from natural sexual interourse. Below are some common male infertility treatments.

Varicoceles are repaired with surgery to block off the abnormal veins. This seems to result in a significant improvement in fertility. Hormonal abnormalities can be treated with medicine, vitamins to improve sperm growth and maturity. Obstructions in the sperm transport plumbing can be surgically corrected.

In the past, if the above methods didn’t work, it often meant lifelong male infertility. Today we have other options such as Assisted Reproductive Techniques (ARTs). These high-tech and expensive male infertility treatments give sperm an artificial boost to get into an egg. ARTs have made conception possible even for men with very low or abnormal sperm.

Other than that, we must avoid marijuana, cocaine, tobacco, and more than two alcoholic drinks a day. Men should also avoid hot baths and whirlpools because the high temperatures slow down your sperm production.

Do not take testosterone, or any over-the-counter androgen like DHEA (for weight training), as this can harm fertility. Of course, adequate sleep and a balanced diet can help with the process.

Visit your doctor for a consultation and investigations and to assist in fertility.

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