Most Common Male Fertility Problems

What many couples affected by infertility are surprised to learn is that for nearly half of them, the problem lies at least partly in the man. And in about 30 percent of these cases, the male is solely responsible for the infertility, according to Larry I. Lipshultz, MD, director of male reproductive medicine and surgery at Baylor College of Medicine in Houston. An estimated 3 million or more American men have fertility problems.

That’s why it’s important when couples suspect a problem that each of them schedules an appointment with a doctor for an infertility screening. Because fertility naturally declines with age in both men and women, men over 40 should think about consulting a physician after six months if conception hasn’t occurred. Younger men can wait up to a year, depending on their doctors’ recommendations.

A general practitioner or internist is a good start for an initial screening, but ultimately a man can ensure a more thorough work-up by seeing a specialist, says Marc Goldstein, MD, director of the Center for Male Reproductive Medicine and Microsurgery at the New York Weill Cornell University Medical Center in Manhattan. “Screening for male infertility is not just about dropping your shorts and having your testicles examined,” he explains. “There are so many things that can contribute to the condition, that a thorough head-to-toe examination is essential to check for things like a thyroid or lung disorder or lack of body hair—just a few examples of things associated with male infertility.” Look for a doctor who is board-certified in urology or has done a fellowship in reproductive medicine to provide such a screening.

The exam should include a detailed medical history, a thorough physical exam, plus blood and semen samples. The semen will be analyzed for things like how well individual sperm move (motility), how many are produced from one sample (sperm count), and their shape (morphology).

The good news: Seventy percent of male infertility cases are treatable. Here’s a rundown of conditions that can cause male infertility, and what docs can do to treat it.

Male Infertility Cause:  Varicoceles
One of the main functions of the testicles is to produce sperm . . . and lots of them. From puberty on, the average male produces 50,000 sperm per minute, or about 1,000 per second. Problems arise when one or more veins in a scrotum sac become enlarged. Called varicoceles, these enlargements are caused by a faulty vein valve that allows blood to back up. Varicoceles are found in 35 to 40 percent of men who are screened for infertility. And while varicoceles can vary in size, the thinking is that those that are large enough to be detected during a physical examination affect fertility, whereas the smaller ones found only through imaging techniques usually don’t cause problems.

Doctors aren’t exactly sure why varicoceles cause infertility, but they do have a few theories: One is that the extra blood increases the internal temperature of the testes, which in turn affects sperm production and quality. Studies also show that men with varicoceles experience a drop in testosterone levels (testosterone, the male hormone, is necessary for sperm production). Still another theory is that poor drainage in the veins leaves the testicles more exposed to toxins, which might damage sperm quality and production.

Left untreated, varicoceles can lead to oligospermia (few sperm being produced) or azoospermia (no sperm). If a varicocele is detected during a physical examination, your doctor will probably recommend surgical repair. The surgery can be done on an outpatient basis under local anesthesia. On average, 50 to 60 percent of partners of men who have this surgery become pregnant within two years.