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Dr. Berger’s Corner: Health Topics from the Medical Director of CHA Fertility Center, Los Angeles

February 21, 2018

Dr. Berger’s Corner: Health Topics from the Medical Director of CHA Fertility Center, Los Angeles

Male Infertility

Although some people still think of fertility as a “woman’s problem,” 33% of infertile couples suffer from male factor infertility. That means it is critical that men get tested for fertility as well as women! It’s also important that men do it early in the process before extensive and invasive testing on the female even takes place. In my practice, it is often the first step to a couple getting the help they need. In the US and the West, sperm counts among men in the west have more than halved in the past 40 years and are currently falling by an average of 1.4% a year. Interestingly, the same pattern has not been seen in Korea!

Many men want to put off being tested. They are embarrassed to explain that they have difficulty getting or maintaining erections. Or that they have a problem performing under the intense pressure of trying to make a baby. I begin every patient counseling session with an honest discussion about male factor too, so that the man understands he is not the only to person to suffer with these issues and that they can often be overcome with simple treatments or interventions.

How do you check for male infertility?

After reviewing the male’s history, a directed physical exam is done followed by a semen analysis, which will check the quality and quantity of the sperm in the seminal fluid. And yes, your doctor will want you to give the sample there, or at least someplace nearby, because it’s important that the analysis takes place quickly and in a reliable place. Just remember, the place where you have the test performed does this all the time. Although it is not common for you, for them it is an everyday thing so don’t be embarrassed. There is a private and isolated place for this in those clinics where the test is performed. The results could save you months of worry and stress.

If the first semen analysis is normal, the doctor typically will not have you repeat the exam. If something in the results looks irregular, your doctor might order further tests to pinpoint the problem. The repeat exam should be done at least 90 days following the first one, because it takes that long for sperm to develop and in the testicles. Most people don’t like to wait that long so many clinics will repeat testing at 6 weeks to see if the results were erroneously low.

What a Semen Analysis Can Detect

  • Low sperm number (oligospermia) or no sperm present (azoospermia).
  • Problems with movement (motility); if sperm aren’t moving normally, they are less likely to be capable of fertilizing an egg.
  • Problems with sperm shape (morphology); problems with the form and structure — or morphology — of the sperm may cause infertility.
  • Signs of infection

Reasons for Male Infertility

There are a wide number of reasons for male infertility. Some are caused by physical problems that prevent the sperm from being ejaculated normally in semen. Others affect the quality and production of the sperm itself.

  • Sexually transmitted diseases or other infections. Genital infections such as chlamydia and gonorrhea can cause infertility in men. The infertility can often be resolved by treating the infection.
  • Blockages, birth defects, or physical damage. In some cases, men are born with blockages in parts of the testicle or other abnormalities that prevent sperm from getting into the semen. Physical trauma to the testicles, prostate, and urethra can also result in fertility problems. Also, previous surgeries such as hernia repairs can sometimes lead to problems. Surgery can may be able to correct those problems.
  • Retrograde ejaculation. In this disorder, semen doesn’t come out of the penis during ejaculation, but instead enters the bladder. It can be caused by diabetes, certain medications, and surgery to the bladder, prostate, or urethra.
  • Genetic diseases. Although it’s rare, genetic illnesses such as cystic fibrosis or chromosomal disorders can cause infertility (Klinefelter’s syndrome).
  • Autoimmune problems. In some cases, the immune system can mistakenly target sperm cells and treat them as if they were a foreign virus. The sperm can become damaged as a result.
  • Hormonal problems. Certain hormonal imbalances — in the pituitary and thyroid glands, for instance — can cause infertility. Your doctor may suggest treatment with medication.
  • Sexual problems. Erectile dysfunction (ED) and premature ejaculation can obviously have an effect on fertility. ED can be caused by psychological problems such as anxiety, guilt, or low self-esteem. It is also caused by physical problems such as diabetes, high blood pressure, high cholesterol, and heart disease. In addition, impotence may be a side effect of medications such as antidepressants.
  • Varicoceles are enlarged varicose veins that develop in the scrotum and prevent blood from flowing properly. Varicoceles are found in 15% of all men and in up to 40% of men being evaluated for infertility. These should be repaired, if present.

Other Factors in Male Infertility

  • Excessive exercise; studies have shown that exercising too much may lead to the release of too many steroid hormones. Frequent bike riding can lead to saddle injuries to the nerves surrounding the prostate, which can lead to ED.
  • Stress
  • Obesity
  • Drugs such as marijuana and cocaine, steroids, drinking excess alcohol, and smoking can reduce sperm counts.
  • Exposure to toxins and environmental hazards; pesticides, lead, radiation, radioactive substances, mercury, and heavy metals may affect fertility.
  • Heat; although the effect is usually temporary, high temperatures in the testicles could reduce sperm production. High heat could result from wearing clothing that’s too tight and traps heat, or by taking too many hot baths or saunas.

Treatments

In some cases where the man has mild infertility, especially that caused by erectile dysfunction or premature ejaculation, artificial insemination may be the simple “cure”.  In extreme cases, when there is no sperm present in the semen, sperm can still be retrieved from the testicle itself and later used for in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). This is a laboratory procedure in which sperm and eggs are retrieved from both partners, and then a single sperm is injected into an egg. The fertilized egg is then implanted into the woman’s uterus.

I always tell my patients that infertility is a medical condition, like high blood pressure. Don’t let embarrassment or fear prevent you from getting the medical information you need to be happy. Also, it takes three months to make new sperm, so even if you gave up smoking and drinking, it takes time to see the positive benefits from that (although you may feel better even sooner).

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