Infertility affects approximately 1 in 8 couples. While it’s often thought about as a female reproductive issue, approximately 30%-40% of couples struggle to conceive due to male factor infertility.
We asked Dr. Samuel Ohlander, a board-certified Urologist with the University of Illinois who recently joined Fertility Centers of Illinois as a part-time physician, the 10 most common questions patients ask about male infertility:
Q: How common is male infertility?
A: Findings show that male infertility is just as common as female infertility. Overall, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors.
Q: What are the symptoms of male infertility?
A: Some signs include an inability to ejaculate or a small volume of seminal fluid being released upon ejaculation. Red or pink semen can indicate blood is present. Pain, swelling or a lump in the testicular or genital area can also indicate a health issue. If a man has experienced blunt force trauma to the genitals or undergone cancer treatment, it is best to seek a medical evaluation prior to trying to conceive.
Q: What are the causes of male infertility?
A: The causes of male infertility can vary from a wide spectrum of diagnoses. Causes of male infertility include:
Varicocele: The presence of swollen or dilated veins surrounding the testicles, commonly present in the left testicle, causing damage to sperm. Approximately 15 out of 100 men are diagnosed with a varicocele.
Sperm Flow Blockage: Different conditions can cause a blockage in sperm flow, and these can commonly be corrected with minor surgery. Blockages can cause sperm count to be extremely low or not present at all.
Hormonal Problems: Hormonal issues, sometimes caused by excess weight, can decrease or halt sperm production.
Genetic Abnormalities: Missing, extra, broken or misshapen chromosomes, sperm DNA fragmentation, or damaged individual genes on the Y chromosome can impact male fertility.
Infection: Prostate or epididymis infections can have a significant impact on male fertility.
Oxidative Stress: Reactive oxygen or oxidants in the semen can damage the sperm cell membrane and DNA.
Medication & Treatment Side Effects: Certain medications or medical treatments can interfere with sperm production.
Q: How is male fertility diagnosed?
A: After taking a complete medical history and undergoing a physical examination, a semen analysis is completed to measure the quantity and quality of semen. Additional tests, including diagnostic and genetic testing, may be necessary based on preliminary findings. An ultrasound may be used to detect a varicocele or sperm tract abnormality.
Q: How is the health of semen evaluated?
A: The health of semen can only be evaluated properly by an andrologist through a semen analysis. The health of semen is evaluated by three main factors: motility, morphology and count. Motility refers to the ability of a sperm to move effectively. At least 40% should be moving forward rapidly, with at least 50% swimming forward, even if movement is sluggish. Morphology pertains to the shape of a sperm, with a normal-sized head and tail being ideal. At least 14% of sperm should be of normal shape. Sperm count refers to the amount of sperm present in seminal fluid. The concentration of sperm should be at least 15 million per milliliter, with a total volume of semen of at least 2 milliliters. It is normal for up to 25% of semen to be dead. The goal is to see at least 75% of sperm alive.
Q: When it comes to sperm count, what is a “normal” range?
A: The normal range for the number of sperm per milliliter spans from 15 million to 100 million. Sperm counts below 10 million are considered poor while a sperm count of 15 million or more may be fine if motility and morphology are normal. A complete lack of sperm occurs in about 10-15% of men who are infertile.
Q: What can a man do to boost fertility?
A: Semen health can rapidly improve by maintaining a healthy BMI, eating a healthy diet, exercising regularly, drinking in moderation and taking vitamin supplements. Taking a daily multivitamin can boost sperm health: Zinc increases sperm count and function, Folic Acid can reduce sperm abnormalities, Vitamin C boosts sperm motility, and Vitamin D assists in healthy sperm development and libido. An additional Coenzyme Q10 supplement of 200 mg per day can improve sperm count and motility.
Q: What common factors hurt male fertility?
A: Excess weight can cause hormone imbalances, which can decrease sperm quality. Smoking cigarettes and marijuana can also damage sperm quality, as can drinking excessively. Contrary to popular belief, hot tubs, cell phones and laptops do not cause male fertility, but excess heat around the genitals doesn’t help. This includes cycling for several hours at a time. If you and your partner use lubrication, be sure to use Pre-Seed lubricant or an oil-based lubricant since water-based lubricants (Astroglide, K-Y Jelly) can inhibit sperm movement by 60-100% within 60 minutes of intercourse.
Q: Are there genetic or aging issues that hurt male fertility? Does family history matter?
A: A study published in the journal Nature found that paternal fertility decreases with age. The study found a link between paternal age and an increased risk of autism and schizophrenia. Other genetic abnormalities involving abnormal chromosomes, sperm DNA fragmentation or inherited diseases may affect male fertility and require further evaluation.
Q: What is a common fertility treatment protocol for a man with infertility?
A: Treatment can range depending upon the diagnosis. Low sperm count can be treated by placing semen through a sperm wash and completing an Intrauterine Insemination (IUI). Should IUI not result in pregnancy, In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) provides a high chance of success. A lack of sperm due to anatomical abnormalities such as retrograde ejaculation may be corrected surgically. If ejaculation is not possible, sperm can be aspirated from the testes and used in IVF. Donor sperm is available for those who have undergone cancer treatment and no longer have viable sperm.
No man wants to find out that he has male factor infertility. The good news is that there are several treatment options for male infertility, so it shouldn't prevent him from becoming a dad. If you are struggling with male infertility, schedule an appointment today by calling 877-324-4483.
About Dr. Ohlander: Dr. Samuel Ohlander practices in the Department of Urology at UI Health. Dr. Ohlander specializes in male infertility, fertility preservation, low testosterone, vasectomies, and microsurgical vasectomy reversals. He also treats patients with erectile dysfunction, sexual dysfunction, penile prosthesis implantation, and Peyronie's disease.