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Houston Fertility Journal

Is it Him? What You Need to Know About Male Infertility

[fa icon="calendar"] Feb 19, 2019 10:30:21 AM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Trying to get pregnant is an exercise in deep and intense emotions. In the first few months, you may feel excited and overwhelmed. Perhaps you even begin shopping for the nursery or stocking up on baby clothes. After all, the baby will be here soon, right? Yet for many couples, this excitement eventually gives way to frustration, and even demoralization. About 15% of couples struggle with infertility, even after a year or longer of trying to get pregnant. Advice about infertility often focuses on the woman. But in at least 20-30% of cases, the issue is solely with the man. And in 20-30% more, there’s an issue with both the man and the woman.

If you and your partner are struggling to get pregnant, don’t assume that the problem is with the woman. It takes two people to make a baby, and the problem could be with either--or both. Male infertility testing is relatively non-invasive, and may offer a quick route to a healthy pregnancy.

Male Infertility: An Often-Ignored Problem

For thousands of years, human societies have constructed myths to explain fertility. These myths gave us a sense of control over our own destiny and helped people deal with the colossal pain of infertility. Unfortunately, these myths almost always blamed the woman for infertility.

And this not-too-distant past still colors our perceptions. Because women are the ones who carry the baby, because women are still culturally more associated with children than men, and because of a long history of blaming women for infertility, we continue to treat infertility as a woman’s problem.

Here’s the truth: infertility is a medical condition. It’s not something for which anyone is to “blame.” That sort of thinking is harmful and can hinder infertility treatment.

When couples only pursue infertility treatment for the woman, they ignore an important piece of the puzzle. They may shell out hundreds or even thousands of dollars to test and treat the woman, completely neglecting half of the problem.

Male infertility is real and very common. To improve your chances of a successful pregnancy and to minimize the time and money you invest in infertility treatment, consider testing and treating both partners.

Is It Him, Her, or Both?

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But isn't it usually the woman? It’s a question we hear in our clinic a lot. An issue with the woman plays a role in about 50% of infertility cases. But male infertility is the sole culprit in an additional 20-30%.

Here’s what many couples don’t think about: In the remainder of infertility cases, there are issues with both the man and the woman.

That’s why it’s so important to test both parties. Identifying a problem with the woman does not mean there’s not a problem with the man. Moreover, if you treat only one partner, you may be throwing away money on a treatment that is doomed to fail because you have not treated both partners.

So what causes infertility? Among women, the most common culprit is an issue with ovulation. The woman might ovulate infrequently or not at all, or her eggs might be of low quality. Other common culprits include hormone imbalances that make it difficult for the egg to implant in the uterus before a woman gets her period, structural abnormalities, infection, and tube blockages.

So what causes male infertility? Most cases are due either to structural issues that make it difficult for a man to have sex or ejaculate, or issues with the man’s sperm. In the former case, the couple will likely know that there is an issue. In the latter, there are rarely any detectable signs.

Some of the most common sperm issues in male infertility include:

  • Lack of sperm. In about 10-15% of cases, the man does not produce any sperm.
  • Problems with the sperm. Sometimes a man produces sperm that cannot easily swim to the egg, or that are of low quality. In other cases, low sperm count lowers the chances of a sperm successfully reaching the egg -- especially if there are also other problems with the sperm.
  • Varicocele. In about 40% of infertility cases, the man has an abnormality with a vein that supplies the testicles with blood. This is called a varicocele. Varicocele can lower sperm count and alter sperm quality.

What About Unexplained Infertility?

In about 50% of male infertility cases, doctors cannot identify a cause. This is called unexplained infertility, and as you can imagine, unexplained infertility can be very frustrating. This doesn’t necessarily mean the couple can’t conceive, it's just a diagnosis that they’ve ruled out the most common causes of infertility for both partners, and at this time don't know what is causing their struggle.

But don’t get discouraged, the right treatment could help. A doctor may work with you or your partner to maximize fertility by ensuring the woman ovulates regularly, or aid in suggested lifestyle changes to promote better health, which may help with sperm quality. You’ll also want to make sure the doctor has done a full workup and utilized all the appropriate tests since you don’t want to leave any stone unturned.

If infertility persists, assisted reproductive technology may be able to help you have a child. In vitro fertilization (IVF) and intrauterine insemination (IUI) are highly effective treatments even when the cause of the infertility is unclear.

Signs of Male Infertility

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Many men mistakenly believe that if they are infertile, they’ll know. Some believe outdated myths about a link between infertility and sexual performance. The truth is that the overwhelming majority of men who are infertile have no symptoms at all. Or if they do have symptoms, they are so subtle that they go unnoticed.

If a man cannot get an erection, have intercourse with his partner, or ejaculate, then he will not be able to have a child--even if his sperm count is normal and healthy. So men with serious sexual dysfunction issues should see a doctor before they begin trying.

Some more subtle symptoms that indicate a man may be infertile include:

  • Unusual sensations, such as pain or burning, before, during, or after sex.
  • Being over the age of 45.
  • Having a history of cardiovascular health issues.
  • Taking certain medications. Ask your doctor if any prescription drugs you take may compromise fertility.
  • A history of sexual problems.
  • Difficulty smelling things.
  • Pain when urinating.
  • Chronic or recurring respiratory infections.
  • Signs or symptoms of low testosterone, such as very little body hair.
  • Abnormal breast growth.
  • Blood in the semen.
  • Pain or swelling in the testicles or penis.
  • A history of STDs, especially if they have not been fully treated.

Male Infertility Testing

For most men, infertility testing is as simple as giving a sperm sample. In a clinic or in the privacy of your own home, you will ejaculate into a cup. A lab will then test the semen to see how many sperms it contains and to check for problems with the sperm.

While sperm issues are the most common culprit in male infertility, they are not limited. So a doctor may recommend additional testing, particularly if you and your partner have unsuccessfully tried to get pregnant for longer than a year.

Those tests may include:

  • Hormone tests to see if testosterone levels are normal.
  • A physical examination to check for malformations in the penis or testicles.
  • Post-coital tests. These are tests to see how sperm interact with your partner’s chemistry. You’ll have sex with your partner and then a doctor will examine her to see how her body is reacting to your sperm.
  • Imaging scans. Rarely, if a doctor suspects something internal is structurally wrong, they may order imaging scans of the penis or testicles.
  • STD testing.
  • Testing for other infections or disorders. Inflammation, infections, and other diseases may affect fertility, so it’s important to test your overall health.
  • Cardiovascular health screening. Coronary artery disease and other cardiovascular health issues can affect sexual functioning and ejaculation.
  • Genetic testing. Some men with certain rare genetic conditions may have trouble getting their partner pregnant. Additionally, genetic disorders may increase the risk of a partner having frequent miscarriages.

Is There Anything I Can Do To Improve Fertility?

The Internet is full of potions and pills that promise to help you make a baby faster. The truth is that these are unlikely to work. Being in generally good health may improve fertility, but improving your health won’t correct serious fertility issues. So if you’re trying to get your partner pregnant, focus on overall health.

Some things you can do include:

  • Don’t smoke or drink alcohol to excess.
  • Take only the medications you absolutely need.
  • Treat any underlying medical conditions.
  • Avoid illegal drugs.
  • Eat a healthy, balanced diet.
  • Get plenty of exercise.
  • Maintain a healthy body weight.
  • Control your stress.
  • Take a multivitamin.

Another important strategy is to understand how fertility works. In theory, all adults know how babies are made. But the ins and outs of fertility often prove elusive. Particularly if you have a condition that undermines fertility or if you ovulate infrequently, timing intercourse correctly is key to successfully making a baby.

Do you know how to time intercourse for optimal fertility? Do you know when you’re ovulating? Work together to learn all you can.

Some tactics that can help you correctly time intercourse and avoid wasting time include:

  • Knowing the signs of ovulation, such as a change in your cervical fluid.
  • Track your cycles. Basal body temperature testing is a great way to predict ovulation.
  • Using an ovulation predictor test to help pinpoint the time of ovulation.
  • Having intercourse at least every other day around the time you’re most likely to be ovulating.

When to Seek Help

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It’s never too early for a fertility consultation. In both men and women, fertility declines with age.  So it’s important to seek treatment as early as possible if you think there might be a problem. Every month you spend delaying is a month you could have spent on a more successful strategy.

If you have tried for longer than a year to have a baby with no luck or with multiple miscarriages, seek treatment now.

Consider also seeking treatment if:

  • The woman is over 35 or the man is over 40 and you’ve tried for longer than 6 months.
  • You or your partner have a history of infertility.
  • Your partner has a condition known to decrease fertility, such as low testosterone.
  • You’ve had two or more miscarriages in a row.
  • You or your partner has a serious medical condition.

Some people also opt to see a fertility specialist before they start trying. If you’re in your late 30s or early 40s, this is wise because it saves you the pain of wasting time. Instead, you can get a full workup and adopt strategies to increase fertility.

How a Fertility Specialist Can Help With Male Infertility

Infertility is challenging. It cuts to the very core of what it means to be human. It can lead to relationship disputes, make sex feel like a chore, and inspire significant uncertainty about the future.

That’s why so many couples are reluctant to see help. They don’t want infertility to become the center of their life. They don’t want to dedicate months to expensive treatments. They worry that seeking help means they’re giving up. Nothing could be further from the truth. Moreover, fertility treatment is often affordable. It’s not just limited to IVF. You have options you might not even know about. 

Infertility treatment works. The right doctor can diagnose the problem and design a treatment plan based on your values, budget, and goals. In some cases, pregnancy could be just a month or two away. So don’t avoid help. You and your partner deserve it.

Some treatments that may help include:

  • IVF and IUI
  • Using donor sperm
  • Treatments to address underlying issues such as low testosterone
  • Fertility surgery for conditions such as varicocele
  • Treatments to ensure you’re ovulating regularly

And much more.

Perhaps even more importantly, the right infertility specialist understands your pain. They can offer you the profound reassurance that you are not alone and that there is hope. They can connect you to resources such as support groups and education. They make this journey feel less lonely and more productive.

The Center of Reproductive Medicine, located in Texas, specializes in one thing: helping people become parents. We use treatments that work. And our results speak for themselves. We'll work with you to craft a customized treatment plan that maximizes your chances of a successful, healthy pregnancy.

We’re here for you. Don’t wait. Don’t suffer alone. We can help. Give us a call today!

Getting Pregnant 101: Facts, Myths, and Secrets To Fertility

Topics: Signs of Infertility, Male Fertility Testing, Male Infertility

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