Male Fertility

Infertility is not just a female issue.  50% of the times when a couple has difficulty with conception, it is related to the man.  One of the causes of infertility that is becoming increasingly common in young men is infertility related to testosterone supplementation.  Many of the corner store “men’s health” clinics popping up all over are so eager to sell their testosterone related products to all men entering their doors that they fail to discuss how testosterone supplementation may affect fertility.  Testosterone supplementation decreases sperm counts significantly and it can take months for levels to return to normal when a patient stops using supplemental testosterone.  Additionally, a Men’s Health specialist is uniquely able to evaluate the causes of male infertility and an semen analysis and make medical and surgical recommendations that may improve the chances of conception related to male factor infertility.

A simple way to categorize male fertility barriers is to divide problems into obstructive and non-obstructive problems. Obstructive problems indicate a blockage somewhere in the male reproductive tract from the testicle all the way into the urethra.  Most obstructions can be surgically repaired.  Non-obstructive problems indicate an impairment in sperm production.

What causes male infertility?

  • Vasectomy – This is the most common cause of OA. This surgical procedure disrupts vas deferens (sperm duct) to stop the flow of sperm. A vasectomy reversal or sperm retrieval are viable options to treat obstructive azoospermia after vasectomy.
  • Radical prostatectomy – Similar to a vasectomy, this surgical procedure interrupts the flow of sperm. Sperm retrieval procedures are viable options to treat obstructive azoospermia after radical prostatectomy.
  • Severe infections of the male reproductive tract – Infections of the testicles, prostate, or epididymitis can cause scarring and blockage in the small tubules of the epididymis or ejaculatory duct.
  • Congenital Conditions – In some cases, men are born missing a portion of the vas deferens, blocking the flow of sperm out of the testicles. In other cases, men are born with a cyst in the prostate that blocks the path of sperm out of the ejaculatory ducts.
  • Varicocele – The most common cause of male infertility due to varicose veins around the testicles. While most varicoceles only cause a minor decrease in total sperm counts, in some cases, the varicocele can result in azoospermia. This is easily corrected through a surgical procedure called a varicocelectomy.
  • Steroid/Testosterone-induced – one of the most common causes of NOA. Men with a history of testosterone replacement therapy use will have poor or no sperm production. This can often be reversed.
  • Chronic Narcotics – Men on chronic narcotics often have impaired testosterone and sperm production that can be reversed. 
  • Sertoli-Cell Only Syndrome (SCO) – In this scenario, the germ cells that divide and become sperm are absent from the testicular architecture. Approximately, 15-20% of men with SCO will have some low level of sperm production occurring in the testicles. Since abnormal sperm production in the testicle is not homogeneous, one region of the testicle might have an SCO pattern, while another area might have some germ cells and some mature sperm. Using microsurgical sperm extraction techniques, we are able to examine the seminiferous tubules and identify the regions that could potentially have germ cell activity.
  • Maturation arrest – Problems in sperm development cause the testicle to be comprised of only precursor sperm. There is roughly a 50% chance of finding mature usable sperm in the setting of maturation arrest.
  • Chromosomal/Genetic Abnormalities – Chromosomal abnormalities include aneuploidy, where there is a presence of an abnormal number of chromosome or translocations, where a part of one chromosome break off and attaches to another chromosome. The most common chromosomal problem causing azoospermia in men is, Klinefelter Syndrome, where there is an extra X chromosome.

The Y-chromosome is what provides men with their “male characteristics” and is intimately involved in sperm production. A common genetic cause of azoospermia is a deletion of the genes on the Y-chromosome. Azoospermia can happen when one or more of the genes on this chromosome are deleted.

Although genetic causes of azoospermia are not reversible, most men still produce small amounts of sperm that can be used to achieve biologic fatherhood.

  • History of Chemotherapy and Radiation :Chemotherapy and radiation therapy for previous cancer therapy can cause temporary azoospermia. However, sperm production should return to normal within two years following therapy, depending on the type and length of treatment received.

If you’ve been diagnosed with infertility, we like to first discuss potential lifestyle changes that could improve your chances of conceiving. By improving overall health through, weight loss, a good exercise regimen, and a protein-rich, and a low carbohydrate, high vegetable diet, we can work together to improve your fertility.  Your Men’s Health Institute physician can provide you with tips to be successful in lifestyle modification.

If hormonal abnormalities are causing infertility, you could be a candidate for hormonal therapies that will help optimize your sperm parameters.

Finally, if you have non-obstructive azoospermia, you may still have some sperm in the testicles.  You’d be a candidate for a microsurgical testicular sperm extraction (Micro-TESE). This is a highly technical procedure that can maximize the chances of successful sperm retrieval and pregnancy.

Have a question or want to schedule an appointment?

Board-certified, fellowship-trained urologists staff Tower Men’s Health. We will pair you with one of our many experienced physicians to help address any concerns you may have and help you on your journey towards improved quality of life. Feel free to reach out to the physicians at Tower Men’s Health at 310-854-9898.