Male fertility requires that an adequate amount of “quality” sperm is ejaculated into the vagina and capable of swimming through the cervix, the uterus and the fallopian tubes to fertilize an egg.  A sperm must attach to and penetrate the membrane surrounding the egg and fertilize the egg.

Symptoms of Infertility in Men

Male infertility is due to either abnormal sperm production or abnormal sperm function. Injuries, prolonged illness, chronic health problems, infections, genetic issues, hormone imbalance, dilated veins around the testicle, and lifestyle choices can cause male infertility.

While most men who experience infertility do not have any other signs or symptoms, known symptoms include:

• Problems with sexual function

• Pain, swelling or a lump in the testicle/scrotum area

• Abnormal breast growth

• Decreased facial or body hair

• Low sperm count

Causes of Male Infertility

Male fertility is a complex process. To get your partner pregnant, the following must occur:

• You must produce healthy sperm

• Sperm have to be carried from the testicle into the semen and ejaculated.

• There needs to be enough sperm in the semen.

• Sperm must be motile and be able to bind, penetrate and fertilize the egg.

The main causes of male infertility include: 

• Age: With the increasing age fertility decreases. Males over the age of 40 years may be less fertile than younger men.

• Undescended testicles: in childhood which required medical or surgical treatment.

• Infections: such as chlamydia, gonorrhea and HIV cause inflammation of the testicles (orchitis) or epididymis (epididymitis) and there by interfere with sperm production or transit though the reproductive tract due to scarring.

• Varicocele: Is the swelling of veins that drain the testicle, this causes abnormally high temperature and leads to reduced sperm quality.

• Ejaculation Problems: such as premature ejaculation, failure of ejaculation, and retrograde ejaculation.

• Sexual Intercourse Problems: The problems include trouble maintaining an erection (erectile dysfunction - ED), premature ejaculation, painful intercourse, or psychological or relationship problems that interfere with the sex.

• Tumors: both benign and malignant tumors can affect fertility. Additionally, surgery, radiation or chemotherapy to treat cancer can harm fertility.

• Anti-sperm antibodies: the men’s own immune system attacks their sperm cells.  

• Genetic disorders: including cystic fibrosis, Kartagener’s syndrome, Kallmann’s syndrome, and chromosomal disorders like Klinefelter's syndrome affect male fertility.

• Environmental factors: Excessive exposure to a heat, toxins and chemicals may adversely affect sperm production and function.

• Endocrine Disorders: disorders that affect hormones and endocrine organs including the hypothalamus, pituitary, thyroid, adrenals and testicles can impair fertility. Diabetes is a major contributor to male infertility. Also low testosterone (male hypogonadism) and other hormonal problems are common in infertile men.

• Medications: chemotherapy, antibiotics, testosterone replacement therapy, steroids, antidepressants and medications for high blood pressure can affect fertility.

Health, lifestyle and other causes

• Drug use

• Anabolic steroid use especially testosterone

• Alcohol use

• Tobacco smoking

• Emotional stress

• Depression

• Weight

When to See a Doctor

A visit to a doctor is recommended in cases where you have been unable to conceive a child after a year of unprotected intercourse or in cases of below-listed problems:

• Erection or ejaculation problems, low sex drive, or other problems with sexual function

• Pain, discomfort, a lump or swelling in the testicle or scrotum

• A history of testicle, prostate or sexual problems

• A groin, testicle, penis or scrotum surgery

• Over 40 years of age

• Have known fertility problems

• Have undergone treatment for cancer

• Have a low sperm count

• Small testicles

A visit to a fertility doctor is recommended if you and your partner have been trying for pregnancy for the past 12 months without success. Infertility is a couple’s problem not just men’s or women’s. 

Infertility can be a sign of undiagnosed health problems, so it is important that you get evaluated at West Coast Fertility which provides the latest fertility treatment technology. 

Diagnosis

Initial male fertility diagnosis includes a medical history, physical examination, hormone tests, and semen analyses.

• Medical History: The doctor will ask about your health conditions, surgeries, medications, lifestyle factors, family history, sexual history, and other relevant issues.

• Physical Examination: This is usually performed by a fertility-trained urologist. The doctor will look for signs of underlying medical issues in the whole body with an emphasis on the penis, testicles, and prostate.

• Semen analysis: involves checking the number, movement, and shape of the sperm cells. The quality of your sperm tells much about your ability to conceive.

• Hormonal Profile: The doctor may check your hormones with a blood test.

• Genetics: Genetic testing ranges from a karyotype to evaluation of specific mutations such as Cystic Fibrosis and Y Chromosome microdeletions. In some cases, sperm DNA fragmentation may also be recommended.

A semen analysis is essential in evaluating male fertility. It involves checking the number, movement, and shape of the sperm cells.

• Volume: is a measure of the amount of the ejaculate.

• Count: is reported as a concentration (# of sperm/ml) and total sperm count.

• Motility: is the percentage of moving sperm.

• Morphology: is the percentage of normally shaped sperm cells.

Men with an abnormal semen analysis should consult with a reproductive endocrinologist or a fertility-trained urologist. Most men with an abnormal semen analysis can father children with appropriate treatment.

Sperm DNA Fragmentation: The DNA fragmentation index (DFI) is a test that evaluates the genetic integrity of sperm. Studies demonstrate that men with high rates of sperm DNA fragmentation are at an increased risk for infertility, and their partners may be at increased risk for miscarriage

Male Infertility Treatments

• Hormone and Medical Therapy: hormonal medications including clomiphene citrate and hCG are often used to stimulate sperm production. Antioxidant supplements may also be recommended to improve sperm quality.

• Testicular Biopsy: is performed in cases of very poor or absent sperm in the ejaculate. A small cut is made on the scrotum. The procedure serves both the purposes of finding a cause of infertility and to collect sperm for reproduction.

  • Microsurgical testicular sperm extraction (micro TESE) is a surgical procedure used to retrieve sperm from the seminiferous tubules of a male’s testes. It is used for men with non-obstructive azoospermia.

  • TESA: Testicular Sperm Aspiration

  • MESA: Microsurgical Epididymal Sperm Aspiration

  • PESA: Percutaneous Epididymal Sperm Aspiration

• IUI: Intrauterine Insemination is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and increase the chance of fertilization.

• ICSI: intracytoplasmic sperm injection, with IVF, is a procedure where a single sperm cell is directly injected into the egg. ICSI can be used in conjunction with a testicular biopsy procedure.

• Microfluidic sperm-sorting: ZyMōt device may be used to help separate sperm with low DNA fragmentation for use in IVF, ICSI, and IUI

• Donor Sperm: Donor sperm can be used with IVF or IUI. Donor sperm can be obtained from an anonymous donor through a licensed sperm bank or a known (directed) donor.

Male factor infertility is a complex problem and requires the expertise of specially-trained professionals. Our doctors in Los Angeles and Orange County, CA treat male infertility disorders and provide life-changing medical care for men dealing with infertility and erectile dysfunction. Book an appointment for male fertility evaluation and semen analysis at  West Coast Fertility Center today.