Discussing male infertility is often an effective way to rule out underlying health issues or pinpoint a reason for the problem.
Around 15% of couples may have trouble having a child. Approximately 40–50% of these cases are due to “male factor” infertility and as many as 2% of all men will exhibit suboptimal sperm parameters.
- From chronic conditions and abnormalities with important structures to issues linked to lifestyle habits, there are many reasons why a man’s sperm count might be low.
- For this reason, a urologist may recommend any of the following methods when determining a likely cause and suggesting an appropriate treatment.
The first step in finding a possible source of male infertility is to perform a semen analysis. The sample is collected either in a doctor’s office or with the use of a special condom during intercourse. A laboratory analysis will determine what a man’s sperm count is and look for any abnormalities. A urologist may look at results specific to sperm shape (morphology), sperm movement (motility), and signs of infection. Since sperm counts can vary among samples, multiple specimens are usually examined to produce a more accurate assessment.
The production of sperm and sexual development are affected by hormones produced by testicles, the pituitary gland at the base of the brain, and a part of the forebrain that helps regulate hormone release known as the hypothalamus. Performed by taking a blood sample, hormone testing involves measuring key levels of various hormones produced by these structures, such as testosterone, LH (luteinizing hormones), and FSH (follicle-stimulating hormones), amongst others.
In order to confirm or rule out DNA-related reasons for a reduced sperm count, genetic testing may be recommended. A sample is collected with a blood test to identify karyotype and any problems with the Y chromosome. Results are typically used to diagnose conditions that may be congenital or inherited in nature. Genetic testing may be suggested for the following reasons:
- A man has a very low sperm count
- Sperm analysis has ruled out infections and other possible causes of infertility
- It’s not possible to feel the “sperm tube” (vas deferens)
- A man has testicles that are smaller than what’s considered normal
A urologist might check for structural issues within the testicles and related structures like the tube that collects sperm (epididymis) with a scrotal ultrasound. It’s a procedure that’s done with sound waves that generate real-time images. The test may also be done if it’s suspected that some type of trauma to the scrotum could be contributing to problems with sperm production. Images produced may also be evaluated to look for:
- Specific position of the testicles in the scrotal sac
- Whether or not the spermatic cord is twisted
- Abnormally loose tissue attachments
Infertility isn’t always preventable. However, men may notice improvements by avoiding excessive alcohol consumption, minimizing stress, losing weight, discussing medication changes with their doctor, or avoiding exposure to prolonged heat or warmth around testicles.