Male Infertility

Male Infertility

What is male infertility? — Male infertility is the term doctors use when a man has trouble getting a woman pregnant. In order to get a woman pregnant, a man needs to have a normal number of healthy sperm. Doctors call this a "normal sperm count." Men with infertility can have 1 of the following problems with their sperm:
They have no sperm at all
They do not have enough sperm – This is called having a "low sperm count."
They have unhealthy sperm – The sperm might move too slowly or have abnormal shapes.
There are many reasons that men can have an abnormal sperm count. These include:
Problems in the testicles, such as a block in the vas deferens – The vas deferens is the tube the sperm travels through to reach the penis (figure 1). A block can be caused by a past infection or by a vasectomy. A vasectomy is a surgery a man can choose to have so that he can't get a woman pregnant. In a vasectomy, a doctor cuts or blocks the vas deferens (figure 1).
Having low levels of the hormone testosterone
Genetic problems that men might be born with
But most of the time, doctors cannot explain why a man has an abnormal sperm count.
When should I see a doctor? — In most cases, doctors recommend that a man be tested if a couple cannot get pregnant after having unprotected sex for 1 year. At that time, both the man and the woman are often tested. But if you are worried, talk with your doctor or nurse. He or she might recommend that you have tests done sooner. If your partner is over age 35 and has not gotten pregnant after 6 months of trying, your doctor will start tests at that time.
What tests will I have? — Your doctor will order a test called a "sperm count" to check your sperm. This test counts your sperm and checks to see how healthy they are. For this test, a man needs to provide a sample of his sperm.
If your sperm count is low, your doctor will repeat the test 1 or more times. If repeat sperm counts are still abnormal, your doctor might do other tests. For example, they might do:
Blood tests
An exam to measure the size of your testicles
Tests to see if there is a block in your testicles
What treatments can help men with infertility? — Different treatments can help men with infertility still be able to father children. These can include:
Hormone treatment to increase sperm counts – Some men have low hormone levels and can be treated with hormone shots.
Surgery to open up a block in the testicle – For example, a man who had a vasectomy in the past can have surgery to reopen the tube the sperm travels through (figure 1).
In vitro fertilization, also called "IVF" – During IVF, a doctor takes an egg or eggs from a woman and sperm from a man. The doctor puts them together in a laboratory dish so that the sperm can fertilize an egg. Then the fertilized egg is put into the woman's uterus to grow (figure 2). Many times, a doctor will do a treatment called "intracytoplasmic sperm injection," or "ICSI," along with IVF. During ICSI, a doctor takes only 1 sperm and injects it into the egg. IVF with ICSI is often used for men who have low sperm counts or abnormal sperm. But this treatment can also be used for men who have no sperm in their sample. This is because these men might still have sperm in their testicles that a doctor can take out and use for the procedure.
Do treatments always work? — No. Treatments do not always help a couple get pregnant. The same treatment might help one couple get pregnant, but not another couple.
How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you and your partner, you might want to think about:
How well your doctor thinks the treatment will work
Cost of the treatment – Health insurance pays for treatment in some states, but not all.
How long your doctor thinks the treatment will take
Downsides of the treatment
What choices do I have if I choose to stop or not have treatment? — Couples who choose to stop or not have treatment have other options. They can:
Try to have a baby using another man's sperm, such as sperm from a sperm bank (called "donor" sperm)
Adopt a child
Not have children of their own
Couples can have a tough time making these decisions. You might find it helpful to talk to a counselor or go to a support group for people who are facing the same issues.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15425 Version 6.0
Release: 28.2.2 - C28.105
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