Male Fertility

Infertility, defined as the inability to conceive after one year of unprotected sex, can be a stressful, emotionally draining process for couples. One out of six couples experience infertility; a male factor is fully or partially responsible 30 to 50% of the time.

Thankfully, due to advances in infertility care, the majority of infertile men can be treated. The urologists at Carolina Urology Partners are dedicated to helping couples overcome male infertility to fulfill their dream of having a child.

Causes

The two main treatable causes of male infertility are:
       
  • Varicoceles - a dilated group of veins above the testicles that elevate scrotal temperature and alter sperm production. Varicoceles are present in about 40% of infertile men.
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  • Obstructions - typically related to a prior vasectomy, hernia surgery, infection or inflammation.

Less commonly, sperm production can be affected by:
       
  • hormonal disorders
  • infections
  • erectile or ejaculatory abnormalities
  • genetic disorders
  • environmental and lifestyle factors, such as smoking, that cause "oxidative stress" reactive molecules that can damage sperm

Symptoms

An accurate diagnosis involves testing both partners. Your doctor will perform a thorough history and physical to look for factors that might cause infertility, including any anatomical problems in your reproductive system. The initial lab evaluation likely will include one or more semen analyses and a hormone analysis. The semen analysis will include assessment of sperm count, motility (the percent of sperm actively moving), and morphology (the percent of sperm normally shaped). If your doctor suspects a blockage, a transrectal ultrasound or testicular biopsy may be ordered.

Treatment

Appropriate treatment will depend on the cause of the infertility. Treatment may involve surgery, assisted reproductive technologies, medications or lifestyle changes.

Surgery

  • Varicocele ligation - can usually be treated by varicocelectomy, an outpatient procedure that requires only a small incision. The treatment stops blood flow through the abnormal veins and restores normal scrotal temperature.
  • Vasectomy reversal - the success of this procedure depends in large part on the microsurgical skill and training of the urologist. With a skilled urologist and proper technique, more than 90% of patients experience the return of sperm to the ejaculate. Within a year of the procedure, more than half of couples can achieve pregnancy.
    Vasovasostomy - the most common procedure to reverse vasectomy; it reconnects the separated ends of the vas deferens.
    Vasoepididymostomy - as time passes, reversing a vasectomy is more likely to involve this more complex reconstructive procedure in which a new connection is created between the epididymis, the duct that stores and matures sperm, and the vas deferens.
  • Electroejaculation or electrically assisted recovery of sperm - an electrical probe placed via the rectum stimulates nerves to induce ejaculation when neurological disease prevents it.

Assisted Reproductive Technologies

If intercourse does not result in pregnancy following vasectomy reversal, a collaborative effort with a woman's fertility specialist usually can lead to pregnancy. Sperm retrieval and/or sperm processing sometimes can be used with various assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) to achieve a pregnancy with a high degree of success.

Medications

A range of disorders, including hormonal imbalances, infections and erectile or ejaculatory abnormalities may be treatable with medication. Medication also may help infertile men to produce more sperm when no identifiable cause for the infertility has been found.

Lifestyle Changes

Changes in lifestyle may improve sperm production, including:
  • eating a healthy diet
  • stop smoking and taking drugs; limit alcohol
  • Your doctor may prescribe special vitamin supplements. Anti-oxidants such as Vitamins C and E sometimes improve sperm function and may be helpful for men with idiopathic (unexplained) infertility.