Infertility has historically been a subject relegated to the female realm of reproductive health. A “woman’s problem” discussed at length in OB-GYN exam rooms and many an online forum, the reproductive health of the male partner was frequently left out of what sometimes became an unsolvable equation — leaving a couple with expensive female fertility treatments to pay off and no guarantee of a biological child for the effort.
As a male fertility specialist in practice for more than two decades, my colleagues and I understand an often ignored phenomenon: that nearly half of all cases where a couple is unable to conceive a child are either entirely or partially the result of a problem with the man’s fertility.
[See: The Fertility Preservation Diet: How to Eat if You Want to Get Pregnant.]
With the advent of the internet and a burgeoning “men’s health” movement, I am pleased to see the tide of public education shifting such that the conception equation accounts for male reproductive health, but still not nearly as much as it does female. However, like with any type of public dissemination of information, misconception and misunderstanding still exist.
A couple is generally considered to be sub-fertile or have infertility when they have not been able to successfully conceive a child despite having properly-timed unprotected intercourse for one year or longer. This occurs in approximately 15 percent of couples who are trying to conceive. As previously mentioned, in almost half of these couples, there is a contributing problem with the male partner.
While a semen analysis is the cornerstone of male fertility testing and an important indication of the presence or absence of sperm in the ejaculate, it really isn’t a good “fertility” test. Physicians try to use the parameters of sperm count, sperm motility and morphology (shape of the sperm) to predict if there is a male problem, but it doesn’t tell much about how the sperm are functioning. This often leads to an inaccurate assumption: If there’s a reasonable amount of swimming sperm, everything must be OK.
[See: The Scary Side Effects of Testosterone Replacement Therapy.]
In order to have a more thorough understanding of a man’s fertility, a complete history and physical are required, as well as two semen analyses (because sperm production is not a constant, and both sperm counts and sperm quality can change from one test to the next). In fact, the history and physical exam can be more telling than the semen analysis itself. In some cases, sperm DNA testing can help provide a clearer picture of how the sperm might behave. Since sperm are, in essence, a “DNA delivery device,” it makes sense that examining sperm DNA integrity (intact or fragmented) could aid in diagnosing unexplained infertility, miscarriages and failure of insemination and in-vitro fertilization procedures. As one might expect, sperm with high levels of DNA fragmentation don’t work as well as sperm with normal levels of damage. This information is proving itself valuable in helping couples overcome prior failures to conceive because the sperm damage can either be repaired or bypassed to get better sperm.
[See: Why Can’t I Get Pregnant?]
The causes of male infertility are many and varied and can range from lifestyle issues such as smoking cigarettes or marijuana, heavy alcohol consumption, obesity and the use of hot baths or Jacuzzis to significant medical issues like cancer (including chemotherapy and radiation treatments) or infections of the male reproductive tract. A high fever can cause a temporary decrease in sperm parameters, and a condition called varicocele (varicose veins above the testicles) is one of the most common and treatable causes of male infertility. The most important take-home message is that most cases of male infertility are curable, but our first order of business is the need to recognize that a problem exists and then look at potential causes and options to address it.
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Understanding Male Infertility originally appeared on usnews.com
