Treatments for Male Infertility
The trauma of infertility afflicts approximately 4.5
million couples in the US today. One in ten couples who
are trying to have a baby cannot conceive.
Fortunately, couples can improve their chances for
conception if they are evaluated and treated
appropriately by a urologist and a gynecologist.
When a couple has difficulty conceiving a child, many
people assume that the problem is due to a female
factor. This misconception may be rooted in the
fact that fertilization and fetal development occur
within the female reproductive tract. However, in
50% of all infertility cases, male factors account for or
contribute to the problem. Therefore it is
paramount that if a couple is having difficulty becoming
pregnant, both the man and the woman visit the
An evaluation for male infertility begins with a
directed history and physical. The urologist should
ask about your past history of non-descended testicles,
hernia, mumps, testicular or venereal disease, tobacco,
alcohol, and medication use, and other potential factors.
He should also examine your body, hair distribution, and
If the cause of infertility appears to be
lifestyle-related, your doctor may recommend that you
make some basic changes to your daily habits. For
instance, if you smoke or drink, he will advise you to
stop these behaviors. He may also counsel you to
take a nutritional supplement if he feels that you are
not getting the vitamins and minerals that your body
needs to function effectively. Zinc, for example, is
crucial to sperm development and motility (movement), yet
many American men do not absorb adequate levels of this
mineral through diet alone.
In addition, the doctor may conduct laboratory tests
including semen analysis and hormone studies. Abnormal
sperm count, shape, or motility can all decrease
fertility. Blood hormone levels of LH, FSH, and
testosterone also indicate whether or not the body is
Varicoceole, an enlarged testicular vein, is the most
common and most treatable cause of decreased fertility.
Normally, blood drains away from the testicle via the
testicular vein to the renal (kidney) vein. Forty percent
of sub-fertile men suffer from varicoceole, engorgement
and impaired drainage through this vein. Most urologists
believe that the engorged vein interferes with testicular
temperature regulation. This causes a decrease in
sperm motility and concentration, and results in abnormal
shape. A surgical procedure improves semen quality
in 71% of cases and results in a 40-60% pregnancy rate
after one year.
Another cause of infertility is obstruction of the
tubes, called ejaculatory ducts, which drain the testicle
to the prostate. Complete obstruction of these ducts
results in total lack of sperm in the semen. Partial
obstruction causes low sperm count, decreased volume, and
impaired motility. The urologist can resect the
junction of the prostate and the ducts to restore
fertility in many cases.
In my opinion, the most exciting work on infertility
is in the arena of assisted reproductive technologies.
Sperm from the man is washed, concentrated, and placed in
the womb by artificial insemination. With in vitro
fertilization, doctors fertilize harvested eggs from the
woman's womb and sperm from the man in a test tube. The
fertilized egg is then implanted in the womb. The
pregnancy rate with this procedure is 20%. Finally,
fertilization of the harvested egg can be further
enhanced by inserting the sperm directly into the egg
cell, thereby increasing the chances of conception.
All of these procedures can prove quite expensive,
Many men are infertile because they chose to be. In a
procedure called a vasectomy, a form of birth control,
the doctor severs the tube that delivers sperm to the
semen so that the man can no longer impregnate a woman.
The good news for men who now want to become fathers is
that this procedure can be reversed. Urologists can use a
microscope and reconnect the divided ends of the tube
(vasovasotomy). The return of fertility rate is good as
long as the repair is done within five years of the
initial procedure. Unfortunately, the success rate drops
dramatically after five years
Semenex, which boosts semen volume, has been
known to increase fertility in men who ejaculate low
quantities of semen.