Male Infertility

Diagnosis

Many infertile couples have more than one cause of infertility. Because of this, both partners usually need medical evaluation. Finding the cause can take time, and in some cases no clear reason is identified.

Infertility testing can be costly and may not always be covered by insurance, so it’s important to understand what your medical plan includes before starting testing.

Diagnosis of male infertility typically includes a general physical exam and a review of medical history. This involves examining the genitals and asking about inherited conditions, long-term health problems, past illnesses, injuries or surgeries that could affect fertility. You may also be asked about sexual habits and sexual development during puberty.

A semen analysis is a key test in diagnosing male infertility. Semen samples can be collected in different ways, most commonly by ejaculating into a special container. For those with religious or cultural concerns, a special condom may be used during intercourse.

The semen sample is analyzed in a laboratory to measure sperm count and to assess sperm shape and movement. The lab also checks for signs of infection. Because sperm counts can vary, several semen analyses are often done over time to ensure accurate results. If semen analysis results are normal, further evaluation may focus on the female partner.

Additional tests may be recommended if needed, including:

• Scrotal ultrasound to look for varicoceles or problems in the testicles and surrounding structures

• Transrectal ultrasound to examine the prostate and check for blocked semen ducts

• Hormone testing to measure testosterone and other hormones involved in sperm production

• Post-ejaculation urinalysis to detect retrograde ejaculation

• Genetic testing when sperm counts are very low

• Testicular biopsy to evaluate sperm production and identify blockages

• Specialized sperm function tests to assess sperm survival and ability to fertilize an egg

Treatment

In many cases, the exact cause of male infertility isn’t found. Even when the cause remains unclear, treatment options may still help achieve pregnancy.

Because infertility often involves both partners, evaluation and treatment of the female partner are also important. Assisted reproductive techniques may be recommended depending on the situation.

Treatment options for male infertility may include:

• Surgery to correct conditions such as varicocele, repair blocked ducts, reverse a previous vasectomy, or retrieve sperm directly from the testicles or epididymis

• Treatment of infections using antibiotics, though fertility may not always be restored

• Treatment for sexual function problems such as erectile dysfunction or premature ejaculation through medication or counseling

• Hormone treatments or medications to correct hormonal imbalances or issues with hormone use by the body

• Assisted reproductive technology, including techniques that use ejaculated, surgically retrieved or donor sperm for procedures such as in vitro fertilization or intracytoplasmic sperm injection

When Treatment Doesn’t Work

In rare situations, male infertility can’t be treated and biological fatherhood isn’t possible. In these cases, healthcare professionals may discuss alternatives such as using donor sperm or adoption, based on the couple’s preferences and circumstances.