Male Fertility

Understanding Male Fertility

Natural conception requires healthy sperm that can swim up the female reproductive tract to reach the Fallopian tubes to then fertilize an egg to take place. If sperm quality and/or quantity are suboptimal, this makes conception more difficult. Male infertility accounts for almost half of all infertility cases. While egg and sperm quality are incredibly important to reproductive success, unlike women who are born with all their eggs, men continuously make new sperm starting at the time of puberty. The life cycle of sperm is about 74 days until it is ready for ejaculation.

Luckily for men, sperm quality can significantly improve with lifestyle changes and medical treatment since it takes approximately 3 months to make new sperm! That being said male fertility still declines with age. At age 40-45, sperm quality begins to decline and there is a higher associated risk of genetic and neuropsychiatric disorders (though the absolute risk of this is still low).

Causes of Male Infertility

Male infertility can be caused by various factors, many of which can be diagnosed and treated with the help of modern medicine. Common causes include:

1. Varicocele: This is the presence of enlarged veins in the scrotum, which can raise the temperature around the testes, affecting sperm production and quality.
2. Hypogonadism: Low levels of testosterone or other hormonal issues (like those involving the pituitary gland) can impair sperm production.
3. Genetic Conditions: Genetic disorders like Klinefelter’s syndrome (47,XXY), Y chromosome microdeletions (AZF genes), or cystic fibrosis can lead to male infertility.
4. Infections: Past infections, such as sexually transmitted infections (STIs) or mumps, can damage the reproductive organs and block sperm pathways.
5. Ejaculation Issues: Conditions like retrograde ejaculation (where sperm enters the bladder instead of being expelled) can prevent sperm from reaching the egg.
6. Lifestyle Factors: Obesity, smoking, excessive alcohol consumption, drug use, extreme stress, and exposure to environmental toxins can negatively affect sperm quality.
7. Age: While men can remain fertile longer than women, sperm quality tends to decline after the age of 40, increasing the risk of infertility.

Male Fertility Testing

A thorough evaluation of male fertility typically starts with a semen analysis, which measures the quantity and quality of sperm.

A semen analysis is ideally obtained after 2-7 days of abstinence and immediately evaluated after ejaculation. The following parameters in a sperm sample are assessed:

1. Sperm concentration: The number of sperm per milliliter of semen ( >15 million/ml of ejaculate)
2. Sperm motility: The percentage of sperm that can swim effectively (>40%). Progressive motility refers to motile sperm that can swim in a straight line (>32%)
3. Sperm morphology: The percentage of normal shaped sperm (>4% -WHO criteria).
4. Volume and pH of semen: This assesses the quantity and quality of the semen which, if abnormal, can indicate abnormalities in the male reproductive tract, infections or other medical conditions.

Other diagnostic tests include:

1. Hormone Testing

This can help determine whether there is hypogonadism (low testosterone affecting sperm production) either due to testicular failure or endocrine disorders (hypogonadotropic hypogonadism). Blood tests measure levels of testosterone and other hormones, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

2. Genetic Testing

Genetic tests may be recommended if low sperm concentration is identified. These tests can detect conditions like abnormal chromosome number (like in the case of Klinefelter’s syndrome), Y chromosome microdeletions or cystic fibrosis, which may cause infertility.

3. Imaging Tests

Scrotal ultrasound can detect structural abnormalities such as varicoceles

Male Fertility Treatment Options

Treatment for male infertility depends on the underlying cause. Many men can improve their fertility with lifestyle changes, medications, or medical procedures. Here are the most common treatments available:

Lifestyle Changes

For many men, lifestyle modifications can significantly improve fertility. These changes may include:

• Quitting smoking, reducing alcohol intake, and avoiding recreational drugs.
• Maintaining a healthy weight through diet and exercise.
• Avoiding exposure to environmental toxins, such as pesticides and fragrances.

Medications

Medications can be used to treat endocrine abnormalities or infections that affect sperm production. Some common medications include:

• Hormone Therapy: If low testosterone or other hormonal issues are identified, use of oral or injectable medications such as Clomid or subcutaneous hCG (and/or FSH) may be implemented.
• Antibiotics: If an infection is present, antibiotics can help treat the infection and restore fertility.

Surgical Interventions

Surgery may be required to correct certain physical conditions that cause infertility, such as:

• Varicocele Repair: Varicocelectomy is a surgery that removes enlarged veins in the scrotum, improving sperm production.
• Vasectomy Reversal:For men who have had a vasectomy, the procedure can be reversed to restore fertility.
• Sperm Retrieval:For men with azoospermia (no sperm in the ejaculate), sperm can be surgically retrieved, through various techniques, from the testicles or epididymis for use in IVF.

Assisted Reproductive Technologies (ART)

If natural conception isn’t possible, assisted reproductive technologies can help:

Intrauterine Insemination (IUI): Sperm is collected, washed, and placed directly into the uterus using a catheter, at the time of ovulation.

In Vitro Fertilization (IVF): Eggs are retrieved from the female partner and fertilized with the male’s sperm in the lab. The resulting embryo(s) are then transferred into the uterus.

Intracytoplasmic Sperm Injection (ICSI): This is a commonly used technique in IVF to increase fertilization, particularly when there is male factor infertility, or using previously frozen and thawed eggs (though ICSI is more routinely utilized now in most IVF labs). Here, a single sperm is injected directly into the egg.

Improving Male Fertility Naturally

In addition to medical treatments, lifestyle changes and supplementation can help improve male fertility and maximize treatment success (though it is important to note, they usually don’t replace treatment!). These include:

Antioxidant Supplements: Vitamins C and E, coenzyme Q10, and zinc can help improve sperm quality by reducing oxidative stress.

Exercise: A combination of resistance training with cardio for at least 150 minutes per week can improve testosterone levels as well as other metabolic parameters to ameliorate sperm quality. Excessive exercise should be avoided, as it can sometimes be detrimental to reproduction.

Diet: A balanced diet rich in fruits, vegetables, and whole grains supports reproductive health. Foods high in omega-3 fatty acids, like fish and flaxseed, can also promote better sperm health.

Want to learn more? Contact us at 310-943-5820 or email BH_Reception@havingbabies.com or fill out a form today to schedule a consultation!