For many, infertility is still thought of as a woman’s problem. However, up to half of all cases will involve difficulty with the man’s reproductive system. For this reason it is crucial for both men and women to be tested for infertility problems when the couple is having difficulty becoming pregnant. It might be embarrasing, but discovering these problems early can mean earlier treatment and a successful pregnancy. Testing men for infertility problems is also less invasive and easier then it is for the women.
The arbitrary timeline is 12 months when the couple has not conceived a child after having unprotected and frequent sex. Instead, the better description might be impaired fertility since those couples who continue to try will usually get pregnant in the second year or later. This is because conception is a complex event which is coordinated by different organ systems in the body and developed through the secretion of several different hormones all of which must culminate in ovulation at the same time that sperm is present in the vaginal vault.
When a couple presents to their physician as unable to conceive after 12 months (when they are younger than 30) or unable to conceive after six months when they are older than 30, the physician will often approach this problem in the most cost-effective and time efficient manner possible. By asking the woman to gather two to three months of fertility charts information and testing the man during that time period the reproductive specialists is often able to save time, energy and money.
Identifying the cause of a man’s infertility is as much art as it is science-as is everything else in the health field. In the case of a man’s infertility it should be evaluated and diagnosed by a urologist and not the reproductive specialists.
A urologist will do a thorough history and physical examination. During the physical exam they will look at testicular size and any potential varicocele which may give clues to any hormonal problems. (1) The man will also be asked to give a sperm and semen sample so that an expert will be able to count the sperm, evaluate their shape and movement and include other variables that impact the ability of the sperm to penetrate the egg. (2)
During the semen analysis the lab technicians will also evaluate pH levels, white blood cell counts, fructose levels and liquification time. All of these criteria have a factor in the ability of the sperm to conceive a child.
Prior to his sperm or semen analysis, the man should avoid any ejaculation for two to five days so that the sperm count is at its highest. However, they should not avoid ejaculation for more than one to two weeks because this can lead to sperm which are less active. Men should also avoid any alcohol in the time before the test and avoid as many medications and herbs that are not necessary for any underlying medical conditions. Results of the semen analysis are usually ready within a day or two.
In general terms, the higher number of normal shaped sperm will mean a higher level of fertility. Men who have a lower sperm count or abnormal semen can also still be fertile. If the first semen analysis is normal the physician may order a second one to confirm the results. Having to test again does not mean that there is a significant problem, just that the urologist does not want to overlook any problem which may not have shown up in the first test. (3)
If something does look irregular in the tests the doctor will also order further testing to pinpoint the problem. Interestingly, if there is no semen or sperm at all this can be a good thing because it suggests a blockage that can be corrected with simple surgery as opposed to a hormonal imbalance which is a more complex problem.
A simple issue that happens to some men is wearing their underwear too tightly which elevates the scrotum too close to the body. The extra heat from the body will kill the sperm and render the man infertile. A second reason for increased heat in the scrotum are varicoceles of the testicles. These are similar to varicose veins in the legs. When one or more of the veins becomes inflamed the valves get worn out and the blood runs in the wrong direction overheating the testicle and damaging the sperm cells.
While testosterone and multiple other hormones control sperm production, release and storage they are not usually the cause for the majority of the problems of infertile men.
Although somewhat embarrassing for men, testing and evaluation for infertility is less invasive and saves their partners more painful and uncomfortable testing if the issue lies in their court. Because the testing also simple it can be done quickly while the woman is gathering her data about ovulation and fertility for the reproductive specialist.
(1) MayoClinic.com: Male Infertility
(2) Stanford University: Testing for Male Infertility
(3) American Pregnancy Association: Male Fertility Testing