Understanding Male Infertility

By Dr. Charles Obasiolu and Dr. Stephen Lazarou

While having difficulties conceiving can feel very isolating, fertility issues are common. According to survey research from the National Institutes of Health, about one in six couples are unable to conceive after one year of trying. The U.S. Department of Health and Human Services has found that about 30% of the time, a problem with the male partner’s fertility is the single contributing factor to the couple’s inability to conceive. Much of the time, discussions about infertility center on the treatment options available to women, but it is also important to be educated about the various options available to men experiencing infertility.

A couple attempting to conceive should have an evaluation if they are unable to get pregnant within one year of regular unprotected intercourse or if there is suspected history of reduced fertility in either partner. The male partner should be evaluated by a urologist with expertise in male infertility. The evaluation should include a complete reproductive/medical history, physical examination, and at least two semen analyses. Based on the results of the evaluation, the urologist may recommend other tests followed by treatment.

The good news for men is that many of the causes of male infertility are potentially reversible or can respond well to treatment options.

There are several effective treatment options for men with infertility:

• Medication for Hormonal Abnormalities: Medications for prolactin-producing tumors of the pituitary gland, thyroid imbalances, or low testosterone conditions can often be used to treat hormonal abnormalities.

• Removal of Toxic Agents: A wide range of chemical substances can affect sperm quality and/or quantity, including various medications and steroid supplements. The male partner should be carefully screened for these.
• Treatment of Infection: Some men may have infections of the urogenital tract found by the presence of white blood cells in the semen. A course of antibiotics generally can address this problem.
• Retrograde Ejaculation: Intrauterine insemination (IUI) can be performed using semen collected after alkalinization of the urine and washing of the sperm. The washed sperm can also be used for in vitro fertilization or ICSI procedures.
• Varicoceles: These enlarged veins in the scrotum can be treated surgically or embolized (broken up) radiologically.
• Obstructed ducts/Vasectomy reversal:  Men who have a blockage, such as after a vasectomy, may have it surgically reversed. Another option is to bypass the blockage and remove sperm directly from the testis or epididymis and proceed with in vitro fertilization (IVF).
• Testicular Microdissection: Some men with no sperm in the ejaculate may still have a small amount of sperm produced by their testes. A new surgical technique uses a microscope to find some sperm within the testicular tissue, and can provide new hope for some couples.
• ART (Assisted Reproductive Technology): Results of the semen analysis can be used to categorize the severity of male infertility from mild to moderate to severe. Mild to moderate male infertility can be treated successfully with IUI using the male partner’s sperm. With severe male infertility, more efficacious treatments such as IVF with sperm injection (ICSI) are warranted. Intrauterine insemination with donor sperm is a proven, time-tested treatment choice for irreversible male infertility due to azoospermia (total absence of sperm) and results in good pregnancy rates when there are no female infertility factors.

If the problem is not reversible, assisted reproductive techniques such as sperm retrieval in combination with IVF, ICSI, or IUI are possible options.

Dr. Charles Obasiolu serves as the Chief of the Department of Fertility and Reproductive Health at Harvard Vanguard Medical Associates. Dr. Obasiolu is a board-certified obstetrician and gynecologist and a subspecialist in reproductive endocrinology and infertility. He is an active member of the American Society of Reproductive Medicine, Society of Reproductive Endocrinology and Infertility, the Endocrine Society and New England Fertility Society.

Dr. Stephen Lazarou is a board-certified urologist practicing at Harvard Vanguard Medical Associate’s Chestnut Hill-West Roxbury site and a Clinical Instructor of Urology at Harvard Medical School. Dr. Lazarou specializes in the full range of evaluations and treatments of male reproductive issues with an emphasis on fertility preservation for cancer patients, treatment of severe male factor infertility, treatment of men with clinical hypogonadism (symptoms of low testosterone), as well as sexual dysfunction.