Male infertility is a serious issue that can have an impact on many aspects of your life. It’s important to talk to your doctor about the possible causes of infertility and what steps you can take to address them.
Getting Pregnant Requires Four Conditions to be met:
- The father must have healthy sperm that can find an egg
- The mother must produce reasonable egg quantity and quality
- The fallopian tubes need to be open
- The lining of the uterus must be receptive for the embryo
Bottom line, when it comes to fertility, “it takes two to tango,” and sperm are a critical component of any fertility workup.
According to the American College of Obstetricians and Gynecologists (ACOG), men are the source of infertility in 40-50% of all couples. This data seems to be an overestimate in our experience at Positive Steps Fertility, where we find men as the source of infertility closer to 10-20%.
What causes male infertility?
Male infertility is a condition in which the male cannot produce enough healthy sperm to conceive. This can happen for a number of reasons, including genetic defects, hormonal imbalances and lifestyle choices such as smoking and alcohol consumption.
When it comes down to it, the underlying cause of male infertility often boils down to low sperm count or poor sperm quality (motility). The Mayo Clinic states that “normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semenormal sperm densities.” Just because your sperm density might fall below this threshold, that doesn’t mean you are infertile; it simply means that the chances are lower your healthy sperm will find an egg than someone who does fall in the designated range.
The best way to test for these issues is with a semen analysis; this involves collecting a sample from your partner and taking steps to preserve its integrity through freezing.
If you’re unsure where you stand when it comes to fertility testing—or if you feel like something isn’t right—we recommend having an expert look at your results first before proceeding further with treatment options or an IVF cycle.
What causes low sperm count?
There are plenty of factors that could lead to a low sperm count. This is by no means an exhaustive list, but here are some common causes for low sperm count:
- Age: As you age, your sperm count decreases. By the time you’re 40 years old, it’s about half of what it was when you were 15.
- Weight: If you’re overweight or obese, your body may have a harder time producing enough testosterone to keep your sperm count high.
- Alcohol and tobacco use: Drinking alcohol or smoking cigarettes can affect your sperm production through several different pathways—including reducing the amount of testosterone produced in the testes—so they can both be factors in lowering your sperm count.
- Drugs: Drugs such as marijuana and cocaine are known to affect male fertility because they reduce levels of testosterone and other hormones that play roles in reproduction. Some prescription medications also carry a risk for lowered fertility (e.g., steroids). There are even certain types of plastics that can interfere with how well sperm performs its job!
What happens during a semen analysis?
Semen analysis is a common test that you can do at home, or have done for you by a doctor or nurse. It only takes about 15 minutes to complete, and the results are usually available within two weeks.
Semen analysis usually involves first masturbating (ejaculating) into a clean container called a “straw” or “spatula,” then storing it in the fridge for about an hour until it’s shipped off for testing. When making your appointment with your healthcare provider, make sure to ask how long it should be stored before shipping out—some clinics require samples to be collected within 24 hours of collection. The semen sample will then be analyzed under a microscope, looking for:
- Number of sperm cells per milliliter (mL) of semen
- Motility (percentage of sperm cells moving forward)
- Morphology (percentage of sperm cells with normal shape)
What does a doctor look for on a sperm analysis report?
The sperm analysis report is a good place to start your search for answers. On the report, you’ll see the following:
- Motility: How well they swim.
- Morphology: How many have normal heads, midsections and tails. Some doctors have moved away from this methodology, however.
- Total sperm count: The total number of sperm in an ejaculate (30-60 million is normal).
There’s no one test that can determine male infertility, but if several samples are abnormal or deformed then there’s a chance semen quality will be poor. In addition to these standard tests, some doctors use more advanced methods such as chromosome analysis or genetic testing on cells from inside testicles (testes) during surgery or biopsies.
DNA fragmentation indices are one of the more common forms of genetic testing. This method gives you indices that suggest running an extra gradient to clear air of sperm before insemination or IVF, or offer a different approach for the sperm to swim up method. Honestly though, unless you’re using someone else’s sperm, it’s not going to radically shift what you end up doing.
Doctors want to remove oxidative stress in general. They’ll ask you to avoid smoking, heavy drinking, and ultimately be healthy for your sperm’s sake. Even these suggestions, though helpful, are not likely to radically shift the management of sperm.
Even a more recent technological breakthrough like Computer-Assisted Sperm Analysis (CASA) is like building a better mousetrap. A patient might get 1% more motility, but it’s not likely to radically shift where most men are. Simply assessing your total modal count and making sure it’s in a reasonable range (60 to 80 million) is a good way to measure fertility rates. We must recognize that both male and female fertility is on a continuum.
If you are worried about male infertility, talk to your doctor or urologist.
If you are struggling to get pregnant, remember that it takes two, and there is a 20-40% chance it could be the result of a sperm issue. Don’t be afraid or embarrassed. You should ask questions to ensure that they understand the extent of your concern. In some cases, asking for a referral to a specialist can help you get answers more quickly and easily than trying to diagnose yourself or taking expensive tests.
We hope you feel more confident about the types of male infertility testing that are available. If you’re worried about your fertility, it’s always good to talk to a fertility specialist or urologist ! Seek help, and don’t wait to get the care you deserve. Fertility is hard, but don’t destroy a relationship in the process of trying to expand it. Get answers. Get support. Get peace. And find the right path for you.