By: Dr. Gary Bellman on January 15, 2014, 2:22 pm
Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive. Male infertility is diagnosed when, after testing of both partners, reproductive problems have been found in the male partner.
How common is male infertility?
Infertility is a widespread problem. For about 1 in 5 infertile couples, the problem lies in the male partner (male infertility
Are there any signs or symptoms of male infertility?
In most cases, there are no obvious signs of an infertility problem. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
What causes male infertility?
Male infertility can be caused by problems that affect sperm production or the sperm transport process. With the results of medical tests, your physician can find a cause of the problem.
Known causes of male infertility can be:
Sperm production problems
: The most common cause of male infertility is due to a problem in the sperm production process in the testes. Low numbers of sperm are made and/or the sperm that are made do not work properly. About 2/3 of infertile men have sperm production problems.
Blockage of sperm transport:
Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen. This is the second most common cause of male infertility and affects about one in every five infertile men, including men who have had a vasectomy but now wish to have more children.
: In some men, substances in the semen and/or blood called sperm antibodies can develop which can reduce sperm movement and block egg binding (where the sperm attaches to the egg) as is needed for fertilization; About 1 in every 16 infertile men has sperm antibodies.
: Difficulties with sexual intercourse, such as erection or ejaculation problems, can also stop couples from becoming pregnant. Sexual problems are not a common cause of infertility.
: Sometimes the pituitary gland does not send the right hormonal messages to the testes. This can cause both low testosterone levels
and a failure of the testes to produce sperm.
The treatment of male infertility depends upon the underlying cause. Several months to years of treatment are usually necessary to achieve fertility. The treatment often involves both male and female partners.
Blockage of the reproductive tract
- Men who have a blockage in the ducts conveying the sperm from the testis until ejaculation (so that sperm cannot get out) can undergo surgery to correct the blockage; Vasectomy (male sterilization)
is a different type of blockage. Vasectomies
can be reversed in up to 85% of cases; over 50% of couples can achieve pregnancy following vasectomy reversal. However, the more time that has passed since the vasectomy, the less likely vasectomy reversal is to restore fertility.
Treatment of hypothalamic or pituitary deficiency
- In a small percentage of cases (1%-2%), male infertility is due to problems in the hypothalamus and pituitary gland (parts of the brain that regulate hormone production). In this case, treatment with human chorionic gonadotropin (hCG), recombinant human follicle stimulating hormone (rhFSH), also called gonadotropin treatment, is often given.
- Gonadotropin treatment is started with injections of hCG three times per week (or sometimes every other day) for up to six months. Blood tests are used to monitor blood testosterone levels and to adjust the dose if necessary. If sperm cells do not appear in semen after six months of treatment, recombinant human follicle stimulating hormone (rhFSH) is added; this is also given by injection. The success rate for this therapy is high as most men will eventually develop sperm in the ejaculate. In many cases, a total of 1-2 years of treatment is needed to achieve normal fertility.
- A varicocele is a dilation of a vein (like a varicose vein) in the scrotum. Many men with varicocele have a low sperm count or abnormal sperm morphology (shape). The reason a varicocele affects the sperm may be related to a higher than normal temperature in the testicles, poor oxygen supply, and poor blood flow in the testes. This can be treated surgically by cutting the veins connected to the varicocele. However, surgery does not always improve fertility and is not recommended for most men unless there is a large varicocele.
- Treatment is not currently available for some types of male infertility. For example, there is no known treatment when the sperm-producing structures of the testes have been severely damaged or are abnormal. This happens in men with certain chromosomal abnormalities such as Klinefelter’s syndrome and small deletions in the Y (male specific) chromosome.
Men with irreversible infertility and testosterone deficiency
may benefit from testosterone treatment
. Although this treatment may not address a couple's goal of having a child, it can improve the male partner's sexual function and mood and help increase and maintain bone and muscle mass.
If you or a loved one have further inquiries, please contact our office to schedule an appointment.
Current office locations for Board-Certified Urologist, Dr. Gary C. Bellman:
23101 Sherman Place, Suite 304
West Hills, CA 91307
375 Rolling Oaks Drive Suite 115
Thousand Oaks, Ca 91361