Men who have trouble getting pregnant require a combination of factors. These include production of healthy sperm and an unblocked way for them to reach an egg.
Certain health and lifestyle behaviors, such as smoking, recreational drug use and excessive alcohol consumption, can affect sperm quality and production. A varicocele, a condition in which the veins around a testicle become enlarged, can impair sperm function.
Hormone Treatment
In many cases, male infertility can be treated with hormone treatment or medication. These drugs help balance the levels of certain hormones and improve sperm counts, motility, and morphology. Your doctor might also prescribe a special diet to boost fertility.
The first step in diagnosing and treating male infertility is to do a thorough medical evaluation, including a full sexual history. Your urologist will also ask about significant trauma to the pelvic area and testicles, previous surgeries involving the scrotum or epididymis, and your family history of infertility.
Hormonal laboratory testing is recommended for all men who undergo infertility evaluation. This tests for low sperm count and concentration, an abnormal sex drive, and any other endocrine disorders that may be contributing to the infertility.
The most important diagnostic test for male infertility is a semen analysis. The procedure involves obtaining a sample of your semen and testing for sperm count, motility, and morphology. It’s best to perform several specimens over a week period to get an accurate picture of sperm levels. Other tests include a scrotal ultrasound, which shows if you have varicocele or other problems in your testicles and supporting structures, and a transrectal ultrasound, which uses a lubricated wand inserted into the penis to look at your prostate and the tubes that carry semen to the scrotum.
Surgery
In some cases, surgery is used to fix problems that keep sperm from being made, stored, and transported. This can include removing twisted and swollen veins (varicocele) from the scrotum, or fixing a blocked vas deferens. Surgical treatments can also help men with certain genetic disorders, such as Klinefelter syndrome or primary ciliary dyskinesia.
Testicular biopsies may be done to check how well sperm are working. They aren’t usually helpful in diagnosing infertility, but can be useful if there’s a blockage or other problem with sperm production or transport. Specialized sperm function tests can be used to check how well sperm survive after ejaculation and whether they can penetrate an egg.
A complete male fertility evaluation includes a sperm count, blood tests, a physical and urogenital exam, and sometimes a MRI or ultrasound of the testicles. If an exact cause can’t be found, your doctor will recommend treatments that improve fertility or assisted reproductive technology (ART). ART treatments involve using donated healthy sperm or eggs for fertilization in the woman. This can be done with artificial insemination, medicines, or surgery. In rare cases, the cause of male infertility can’t be treated. When this happens, the man and his partner might consider using a surrogate or adopting. It is important to understand that while treatment for male infertility can be successful, the experience is very traumatic for many couples and it is common for both individuals and the couple to feel grief, loss, depression and feelings of failure.
IUI
Male infertility contributes to one-third of fertility issues, and IUI can be a treatment option for many men. The procedure places sperm directly into the female uterus, bypassing the vagina and cervix, giving the sperm a head-start to reach the egg for fertilization. Our doctors can perform IUI as part of a natural cycle or after using medications like Clomid to stimulate the ovaries.
Before beginning a cycle of IUI, your doctor will review your screening bloodwork and imaging studies to ensure you are a good candidate for the procedure. They will also evaluate your uterus and fallopian tubes to be sure they have no structural abnormalities that could prevent pregnancy.
During IUI, your partner will provide a semen sample that is sent to the clinic to be washed and have active sperm separated from the seminal fluid. A frozen sperm donor can also be used for IUI treatments. Both men and women should refrain from ejaculating on the day of and after the IUI to maximize chances of success.
If your test results show low sperm count, your health care provider may recommend RPE (rectal probe electroejaculation) under anesthesia to obtain high concentrations of sperm. Your doctor will also check your hormone levels to determine if there is an underlying problem with the way your testicles produce sperm. The test results will help identify and treat the cause of the sperm production problem, which can often be corrected with drugs or surgeries.
Insemination
While male infertility may seem more common than female infertility, there are treatment options for men. For example, men who have reduced sperm motility (the ability to move forward and fertilize an egg) can try artificial insemination.
A male patient with infertility will need a full workup to find out what is causing his problem. This typically includes a complete medical history and focused genital exam. He will also need to provide a sample of his semen. This will be tested for sperm count, shape and movement, as well as a test to see how fast the sperm moves through the vas deferens.
Blood tests will also be taken to check for a number of conditions that can affect fertility. These include abnormal hormone levels, testicular disease and the presence of anti-sperm antibodies (which are usually due to previous surgery).
It is important for a man with infertility to follow his healthcare provider’s treatment plan closely. This will increase the chances of pregnancy. In addition, men should talk to their partners about reducing the risk of infertility by avoiding smoking, drinking alcohol and working around chemicals. A sperm bank can store frozen sperm for future use in cases where a man is having trouble getting pregnant naturally. A therapist or psychiatrist who is familiar with the emotional and psychological aspects of infertility can help patients cope with feelings like depression, frustration, loss, grief and failure that can accompany infertility.
