Male infertility is often overlooked by patients at the beginning of their journey.
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 and 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.
It’s always surprising to couples when I tell them that approximately 35% of infertility can be linked back to the male in the relationship. Though the cause of male infertility is often unidentified, there are a few problems that have been indicated as potential causes. Problems related to sperm production, the anatomy or structure of the man’s reproductive organs and the man’s immune system can all be factors in male infertility.
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.
Infertility related to structural and anatomical problems in the male anatomy may be caused by scar tissue, varicose veins (varicocele) or infection or, in some cases, the problems exist from birth.
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, 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 that are measured 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 to have the semen analysis done either at our lab or one that’s affiliated with a fertility clinic. It’s a great first step in determining what is causing problems.