Infertility caused by a problem in the male, for example, inability of ejaculate or insufficient number of sperm.
Infertility is not just a disease that affects women—men suffer as well. In fact, new studies show that in approximately 40 percent of infertility couples the male partner is either the sole cause or a contributing cause of infertility.
Diagnosing male infertility problems usually involves:
General physical examination and medical history. This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
Semen analysis. Semen samples can be obtained in a couple of different ways. You can provide a sample by masturbating and ejaculating into a special container at the doctor's office. Because of religious or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, semen can be collected by using a special condom during intercourse.
Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.
Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems also might contribute to infertility. A blood test measures the level of testosterone and other hormones.
Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
Testicular biopsy. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal, your problem is likely caused by a blockage or another problem with sperm transport.
Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change recommendations for treatment.
Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Often, an exact cause of infertility can't be identified. Even if an exact cause isn't clear, your doctor might be able to recommend treatments or procedures that will result in conception.
In cases of infertility, the female partner also is recommended to be checked. This can help to determine if she will require any specific treatments or if proceeding with assisted reproductive techniques is appropriate.
Treatments for male infertility include:
Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
Treating infections. Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.
Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.