Male Infertility

Overview

Approximately 15% of couples are unable to conceive after one year of unprotected intercourse. A male factor is solely responsible in about 20% of infertile couples and contributory in another 30-40%. If a male infertility factor is present, it is almost always defined by the finding of an abnormal semen analysis, although other male factors may play a role even when the semen analysis is normal. An initial screening evaluation of the male partner of an infertile couple should be done if pregnancy has not occurred within one year of unprotected intercourse. If pregnancy has not occurred in 6 months and female partner is >35 yrs of age a workup is also warranted. An earlier evaluation may be warranted if a known male or female infertility risk factor exists or if a man questions his fertility potential.

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Signs & Symptoms

Infertility is defined as the inability of a couple to conceive (become pregnant) after 1 year of trying.

Diagnosis & Treatment

The initial evaluation for male factor infertility should include a reproductive history and two properly performed semen analyses. A full evaluation by a urologist or other specialist in male reproduction should be done if the initial screening evaluation demonstrates an abnormal male reproductive history or an abnormal semen analysis.

Treatment

  • Medical treatments for low testosterone or hormone abnormalities
  • Microsurgical varicocele repair
  • Treatment of blockage of the reproductive tract
    • Vasectomy reversal or microsurgical reconstruction of the reproductive tract
    • Transurethral resection of the ejaculatory ducts
  • Testicular biopsy with sperm extraction

Frequently Asked Questions

What does an initial evaluation include?

The initial evaluation for male factor infertility should include a reproductive history and two properly performed semen analyses. A full evaluation by a urologist or other specialist in male reproduction should be done if the initial screening evaluation demonstrates an abnormal male reproductive history or an abnormal semen analysis.

What is an Abnormal Semen Analysis?

The most current recommendations by the world health organization or WHO are as follows:

  •  Ejaculate volume <1.5cc
  • pH 7.2 or more
  • Sperm Concentration 15million/cc or more
  • Percentage of motility of 40% or more
  • 4% normal morphology or more by strict (Kruger) criteria
  • No sperm agglutination