Male Infertility

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Male factors contribute to approximately half of the identifiable causes of infertility. In 20% of couples suffering from infertility, the male factor is the only identifiable cause.  For these reasons, we think it is prudent to involve the male partner in the evaluation from the outset.

The best predictor of a man’s reproductive potential is his past performance. However, if it has been several years since the birth of his last child, things could have changed for the worse.

The initial testing for the male is quite simple. We take a brief history and ask for a semen analysis. The best semen analyses are performed in fertility clinics, where strict morphology can be performed.

What men are at increased risk for male factor infertility?
The causes of male factor infertility are many and diverse. To list them all here could be overwhelming.

To simplify things, we should think about how sperm are made. Sperm production requires the proper function of a part of the brain called the hypothalamus, the pituitary gland and the testicle. Disruption at any level can dramatically alter sperm production. Similarly, anatomic defects which block the passage of sperm out of the penis can occur. Just because a man produces an ejaculate does not mean there is sperm. Finally anti-sperm antibodies can be present, making the available sperm less motile.

Men with a history of traumatic brain injury, radiation or chemotherapy, low libido (sex drive), low energy, diabetes, or a history of pelvic surgery (even in childhood) should be evaluated promptly.

	The hypothalamus secretes a hormone called GnRH to stimulate the pituitary.	Genetic GnRH deficiencies Anabolic steroid abuse
	In response to GnRH, the pituitary releases FSH and LH.	Benign pituitary tumors Congenital absence of FSH and LH producing cells. Thyroid disease
	LH stimulates the Leydig cells to make testosterone. FSH and locally produced testosterone stimulate Sertioi cells to make sperm. A proper blood supply delivers these hormones to the testicle. The testes need a cool environment to properly process sperm. This is why the testicles hang outside of the pelvis.	Radiation or chemotherapy destruction of germ cells. Absent or malfunctioning germ, Sertoli or Leydig cells Heat: due to varicocele or sauna History of undescended testes Abnormal Y chromosome. Nutritional deficiencies Smoking
	Sperm travel through the epididymus, vas deferense, the prostate gland and out the urethra.	Congenital absence of the vas deferens Prostatitis Antisperm antibodies Previous pelvic surgery Diabetes

If there is an identifiable cause of male factor infertility, one should consider correction, if possible.  In many of these cases, referral to an urologist is warranted.  However, many times there is not an identifiable cause. In these cases intrauterine insemination (IUI), in vitro fertilization (IVF) or donor sperm may be appropriate.

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