What is the cause of male infertility?
- Evaluation of a man’s fertility can be a multistep process for clinicians and patients alike. There are a wide range of potential causes that may contribute to reproductive difficulties including genetic, congenital, medical, surgical, environmental, and psychosocial etiologies. These can include genitourinary anomalies at birth, previous reconstructive surgeries, exposures to chemotherapy or radiation, certain hormone therapies, smoking, endocrine disorders such as diabetes mellitus, previous sexually transmitted diseases, neurologic disorders, or trauma.
How common is male infertility?
- Infertility is affects approximately 15% of couples who attempt to conceive. Male factor infertility may be attributable to approximately 50% of infertile relationships: 30% of couples due to a significant male factor alone and 20% with combined male and female factors. Infertility may be considered to exist after 12 months of attempted conception without any form of contraception. This should be considered in the setting that pregnancy rates through intercourse in couples are approximately 20-25% per month and 90% at one year.
How is male infertility diagnosed?
- The fertility workup requires an assessment of each relationship partner involved. A general workup includes a thorough history and physical. A discussion of the duration of a couple’s infertility, previous attempted treatments, and prior pregnancies is crucial. The history also includes a reproductive and sexual history, identifying any past medical and surgical history, as these will help to identify common causes of infertility. The physical exam will also give important information regarding the overall health of the male, and a focused genital exam may reveal varicoceles (dilated varicose veins), spermatic cord abnormalities, or testicular concerns.
- In addition to the history and physical, bloodwork is routinely performed to evaluate the hormonal interaction between the hypothalamus, pituitary, and testicles.
- Importantly, a semen analysis should be performed. The semen analysis is arguably the most important laboratory evaluation of the male undergoing an infertility workup. At minimum 2 semen analyses should be obtained with a similar duration of abstinence for consistency. The ideal abstinence period is at least 2-3 days. Shorter periods may give artificially low semen concentrations, whereas longer periods may affect sperm motility.
- After the initial workup is performed, testing such as imaging, additional semen investigation, or genetic evaluation may also be warranted.
What are the treatment options for male infertility?
- The treatment options for male infertility depend on the cause. If a hormonal imbalance or production problem is causing the lack or decreased sperm production, medication or adjustments to the hormonal axis may be able to restore or increase sperm production.
- If the cause is an obstruction (as in the case of a previous vasectomy, scarring or inflammation from infection, or epididymal cysts) surgical treatment to restore patency of the vas deferens or bypass the obstruction are options. Additionally, sperm retrieval from the testicle may be performed directly for many of these cases.
Kevin J. Campbell, MD, MS
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