Male infertility is often overlooked by patients at the beginning of their journey.

by Dr. John Storment

Couples often overlook male infertility is often overlooked by couples longing to have a child. Increasing awareness about male infertility issues and always testing the male partner will help couples conceive.

It happens just about every week in my practice. A nice couple walks through the door worried that they haven’t conceived yet. It’s been over a year, they’ve tracked her cycle, had intercourse on the right days, tried a number of old-fashioned remedies, but still no positive pregnancy test. What could possibly be wrong with her body that she can’t make a baby? We start the consultation and go over some possible causes. Invariably, when I get to the subject of male infertility, I see him shift in his seat and look quite uncomfortable. Surely this isn’t my fault is what he’s thinking.

There can be many causes of male fertility

It’s always surprising when I tell couples how common male infertility is. And how often male infertility is overlooked. The cause of male infertility almost always has to do with sperm, but other issues can also be present. Problems related to sperm production are the most common. However, the anatomy or structure of the man’s reproductive organs and his immune system can also be factors in male infertility.

• Problems with sperm production – Genetic defects, infection, testicular trauma, hormonal imbalance or exposure to radiation and certain medications are all causes of sperm production disorders. Infertility can occur when there is a low sperm count, or problems with the motility (movement) or morphology (appearance or shape) of the sperm. Sperm that have poor motility often are not able to reach the egg and, therefore, fertilization does not occur. Abnormal sperm are sometimes unable to penetrate and fertilize the egg. Sperm DNA damage may interfere with conception as well as lead to a greater risk of miscarriage. Any structural or anatomical problems that block the path that sperm must travel to eventually reach the egg for fertilization can cause male infertility.
• Structural and anatomical problems with the male anatomy – Structural and anatomical problems in the penis, testicles, vas deferens, epididymis, prostate or seminal vesicle can lead to infertility when it affects sperm production, inhibits the transport of sperm, or prevents ejaculation. These may include blockages due to infection and scar tissue, varicose veins (varicocele), or erectile dysfunction. In some cases, the problems exist from birth.
• Autoimmune diseases – In some cases, men have immune system disorders which cause their bodies to develop antibodies to their own sperm, which attack and weaken the sperm. The antibodies can also attach to the sperm surface and interfere with their movement or ability to fertilize the egg.

A semen analysis is one of the first tests we do to rule out male infertility

Regardless of what the cause may be, one of the first tests I recommend is a semen analysis. It gives me the most information possible about the reproductive potential for the man. Some of the things we measure include 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); and, if the sperm are the right shape or not (morphology). The analysis can also suggest if you have an infection in your reproductive system.

I’m also pretty picky about what lab does the analysis.  Quite often a hospital lab has very little experience in the more detailed semen analysis and the result is not accurate.  I strongly recommend our patients conduct the semen analysis in Fertility Answers andrology lab or one that’s affiliated with a fertility clinic. It’s a great first step in determining what is causing problems.

Dr. S