Male Infertility
About 15 percent of couples have trouble conceiving after a year of trying. Half of those cases involve “male factor” fertility problems. More specifically, 40% of infertility cases are attributed to the woman, 40% to the man, 10% to both partners, and 10% of the time the cause can not be identified.
Male infertility can be caused by hormonal, chromosomal, structural or unknown abnormalities.
Testing and Treatment
Male Infertility Testing
A semen analysis should be done very early in the couple’s fertility evaluation. The semen sample is reviewed to determine the volume, count, concentration, movement, and structure of sperm. The women’s OB-GYN may be comfortable ordering and interpreting this test, but more commonly, the test is ordered and interpreted by a reproductive endocrinologist or a urologist.
An initial male fertility evaluation also includes a complete physical exam, hormone testing and a thorough review of a man’s medical history. A basic male fertility evaluation should be done before more invasive testing is done on either partner so that any straightforward problems can be addressed.
Depending on the results of the initial male fertility evaluation, a urologist may order additional tests such as an ultrasound of the ejaculatory ducts or a testicular biopsy.
Causes and Treatments
Varicocele: The most common cause of infertility in men is a varicocele or varicose veins scrotum. A varicocele is thought to raise the temperature of the testicles, impairing sperm. Varicoceles occur in 42% of infertile men. They can usually be treated by a urologist during an outpatient surgery called a microsurgical varicoelectomy. After treatment, 90% of patients see sperm return in the semen
Obstructions: Impediments along the male reproductive tract that preventing normal transport of sperm from the testicles outside the body can sometimes be surgically corrected by a urologist.
Hormonal Abnormalities: can sometimes be treated with medicine or surgery.
Sperm Retrieval: If it is not possible to correct the primary cause of male infertility or if the woman has certain kinds of fertility problems, a couple may elect to have a urologist perform a sperm retrieval procedure so that the sperm can be during advanced reproductive procedures such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Sperm retrieval procedures must be coordinated with the couple’s reproductive endocrinologist.
Frequently Asked Questions
Does insurance cover male infertility testing or treatment?
Most insurances do not cover costs related to male infertility. Rarely, some insurances cover diagnostic testing for male infertility. Even more rarely, do insurances cover male infertility treatments. If you have questions about what your insurance plan covers, call the 800 number on your insurance card to inquire, or contact our insurance and billing department for assistance.
Does testosterone therapy affect male fertility?
Men who want to father children should not receive testosterone replacement therapy or take testosterone for bodybuilding. Introducing testosterone through a cream, injection, pellet, etc. causes the brain the shut down its signal to the testes to produce testosterone, decreasing sperm production and directly affecting a man’s fertility.
