Infertility is often viewed as a woman's problem but when a couple has trouble conceiving, there's a good chance it's related to male factors -- in fact, that's the case 40-50 percent of the time. That's why the male partner should be part of any couple's fertility assessment.
Not only is male infertility more common than most people realize, male factors are the sole reason for a couple's inability to have a baby 15 percent to 25 percent of the time. While some reasons for male infertility are well understood, at least 50 percent of problems are due to unknown factors.
Male infertility can occur when men have a less than normal semen analysis because of a reproductive problem such as testicular damage that reduces their chances of getting their partner pregnant and affects development and live birth. Problems with sperm range from producing too few (low sperm concentration or count), movement (low motility) issues or sperm that are not shaped properly (abnormal morphology). Or, there may be physical problems such as a blockage of the reproductive tract that prevent sperm from getting out.
Besides a physical exam and medical history, there are a variety of diagnostic tests that may be used to identify problems and hopefully lead to a solution. These include semen analysis which will look at the quality and quantity of sperm including the volume of semen, the number of sperm, whether they move and are shaped correctly. The semen must be tested within an hour of collection and will likely require two different tests on different occasions as semen results vary. It's important to note that a semen test can be helpful in predicting fertility, but that it is not a perfect test by any means. Many men with somewhat decreased semen analysis numbers still get their partners pregnant, and some with normal semen analysis numbers have sperm that for unknown reasons don't result in a pregnancy with their partner -- even over prolonged periods of time.
If the semen analysis produces results that aren't normal, additional tests may be required that look at how many sperm are alive in the sample (vital stating test); if antibodies have attached to the sperm which makes proper movement a problem (antisperm antibodies test) or if you have an infection or inflammation that affects the semen (peroxidase staining and semen culture tests).
If a man produces little or no sperm, their physician may want to conduct genetic testing to determine if there are any abnormalities that make it impossible to produce sperm. These tests will reveal whether your sperm has the right number of chromosomes (sperm aneuploidy testing) or if there's a chromosome defect (chromosome analysis and/or Y-chromosome deletion testing). They can also determine if there's a problem that could be passed along to offspring. If no sperm are detected, your physician will need to determine if the sperm tubes are intact and possibly perform a biopsy of the testicles.
The reasons for male infertility vary -- we know health status can have an impact--cancer, diabetes and other chronic illnesses or a hormonal imbalance may affect fertility. So, too, can genital infection or trauma and genetic issues. Even surgical treatment for a hernia or undescended testicle may make a difference. Approximately 40 percent of infertile males have a physical problem of enlarged veins known as varicocele. However, the impact of this condition on fertility is difficult to assess, and not all varicocele need to be treated.
In general, the healthier the man, the healthier the sperm. Obesity, excessive use of alcohol, recreational drugs, and smoking may cause problems. So can taking certain prescription drugs such as antibiotics. Stress, dietary deficiencies and excessive exercise--such as cycling--can also have negative effects.
Even environmental factors can influence fertility, including excessive heat exposure which may result from certain occupations--such as welders or firefighters -- or lifestyle including too much time in the hot tub or too tight clothing. Exposure to high levels of pollution, including lead/heavy metals, paint, plus herbicides and pesticides are also associated with higher levels of male infertility.
Research continues to identify new factors that may affect male infertility including using sunscreen and eating too much bacon and other processed meat. The long list of potential negative influences may be daunting but help is available. Talking to your doctor can help identify what your specific problem might be and which diagnostic tests are needed. And, there are many possible "fixes" ranging from lifestyle changes, to male fertility drugs to surgery, and in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI)--to help you both contribute to having healthy babies.