Male Infertility

Causes of Male Infertility:

Among the causes of infertility in men are low sperm production, blockage of the sperm delivery system, antibodies against sperm, injury to a testicle, problems with hormone production, poor descent of one or both testes, or the presence of a varicose vein around the testicle.

Male Fertility Evaluation:

Infertility screening of the male partner typically involves a semen analysis performed in the office of the woman's gynecologist. If any abnormality is found, the man may be referred to a urologist for a thorough physical examination and for laboratory tests.

Lab tests include analyses of semen, urine, and blood. Three semen specimens are collected over three to four weeks after a period of sexual abstinence. The sperm are counted and evaluated for their movement and shape. Test results can show many things. For example, a man whose sperm count is low might otherwise be fertile-if his sperm are healthy and move properly.

For a man with a small semen volume, a normal sperm count may mean that the sperm are being propelled backwards into the bladder during ejaculation. A urinalysis will show if an infection is present in the prostate or urinary tract. Lab tests can reveal information about hormone levels and sperm abnormalities.
Additional Testing Possibilities:

In addition to routine screening, a variety of other tests may be done, including in vitro-or test tube-studies. The cross mucus test, for example, assesses the man's sperm motility after incubation with cervical mucus from his partner and from a proven-fertile donor. In addition, the woman's mucus is evaluated by incubation with proven-fertile donor sperm.

Another important test is the sperm penetration assay (SPA), or hamster test. The SPA, which can often identify a functional abnormality in the sperm, is usually performed last, when other tests cannot explain a couple's infertility.
Male Infertility Treatment:

A successful result for an infertile couple (conceiving a baby) sometimes depends on both partners being evaluated and treated. If it is the man who is infertile, surgery or medication to improve the quality of sperm may be required.

The goal of surgery is to improve the production of sperm or its delivery to the egg. The most common and easily correctable factor contributing to poor semen quality is a varicose vein, or scrotal varicocele. Scrotal varicoceles, found in 15 percent of the general population, have been reported in as many as 40 percent of men seen in infertility clinics.

In 30 to 40 percent of infertile men, the problem cannot be identified: they have a normal penis and hormone profile, and no apparent reason can be found for their abnormal semen analyses. These men, classified as having an unexplained, abnormally low sperm count, can sometimes be treated with antiestrogens, a medication that increases the serum levels of the male hormones.