Most men don’t spend much time thinking about fertility until it’s time to start a family. So, couples often are surprised to learn that male factors contribute to infertility about half the time.
Fortunately, many men have options that can improve their chances of becoming a father. Below, UAB Medicine urologist and fertility specialist Patrick Murray, M.D., answers some common questions about male infertility.
What does male infertility actually mean?
It means that the quantity or quality of sperm is making it more difficult to achieve a pregnancy. Infertility is generally defined as failure to achieve pregnancy after 12 months of regular, unprotected intercourse. About one in six couples will deal with some sort of infertility, and about half the time there’s an issue on the male side contributing to it.
How long do we need to try for a pregnancy before I can get checked?
You don’t have to wait a year to start the conversation. If you have concerns, you can ask your primary care provider about a semen analysis or contact UAB Medicine Fertility Services.
Infertility is generally defined as being unable to conceive after one year of trying. However, if your partner is 35 or older – or there are other factors such as a prior surgery or chemotherapy – it may be a good idea to begin an infertility evaluation after about six months. Evaluation typically starts with a semen analysis and often includes a physical exam, hormone testing, and sometimes additional testing depending on the initial findings.
What causes male infertility?
Many things can cause male infertility, but I like to think of it in three categories: Is there a problem with the factory? Is there a problem with the plumbing? Or are there lifestyle factors getting in the way?
- The “factory” includes problems with sperm production, such as genetics, hormone imbalances, enlarged veins around the testicle called a varicocele, or prior chemotherapy or radiation.
- The “plumbing” includes conditions that result in the absence or obstruction of the tubes that carry sperm from the testicles to the penis.
- Lifestyle factors such as excess weight, alcohol/marijuana use, and other health habits also can affect fertility.
Another increasingly common lifestyle factor is testosterone replacement therapy (TRT). Many men assume it improves fertility, but TRT almost always has the opposite effect.
Isn’t testosterone needed for fertility?
Yes, but only the testosterone that your body produces naturally contributes to fertility. TRT puts your testicles in a resting state that disrupts their natural testosterone and sperm production. Especially for young men, it’s important to know that TRT or steroids can have the opposite effect on fertility than many people expect. Although sperm production often returns about 3-6 months after stopping TRT, it can take much longer and require special treatment. And in some cases, it may not return.
Can male infertility be treated?
Yes. Treatment is specific to the cause, and there are many treatable causes. For example, if infertility is related to TRT, stopping it often allows sperm production to return over time. If it’s caused by a varicocele, repairing it can significantly improve semen quality. And if it’s caused by a previous vasectomy, a vasectomy reversal often can restore sperm to the semen.
Sometimes we can improve fertility enough to move from needing in vitro fertilization (IVF) to trying intrauterine insemination (IUI), or from needing treatment to conceiving naturally. I like to think of it as moving patients into different thresholds of fertility. The goal is to improve fertility as much as possible and give couples the simplest path to pregnancy that is realistic for them.
Does male infertility mean that I won’t be able to father children?
Not necessarily, and there’s good reason for optimism. In the past, some men with severe infertility were told they had no chance of fathering a child. Today, even men with no sperm in the semen may still have options, depending on the underlying cause. Modern reproductive medicine has greatly increased the number of people who are able to have children.
Read more information about UAB Medicine Fertility Services or to make an appointment. Also, you may learn more by visiting the UAB Medicine male infertility page.