Couples looking to conceive are often hypersensitive about their fertility. Many couples do not realize how long it can take to conceive – the general guidance for seeking fertility assistance is after about one year of trying. We’ve also learned much more about the causes of infertility over the past few decades, and we now know that male infertility accounts for about 50% of all cases. Before we get into testing, it is important to understand why males may be infertile. Ultimately, there are three overarching reasons:
- First is a production problem. If the testes do not produce enough semen or sperm, they typically cannot reach the egg for fertilization.
- Second, the shape (morphology) and movement (motility) of the sperm will also play a role, as these dysfunctional or deformed sperm cannot efficiently travel to the egg.
- Finally, some men will also experience a blockage that prevents sperm from being ejaculated.
How We Test for Infertility
When couples suspect infertility, the next step is to see their respective sexual health specialists. For men, a urologist and men’s health specialist like Dr. Kapadia has the tools and diagnostic equipment to best assist. We take a stepwise approach toward understanding what issues, if any, may be preventing our patients from conceiving. These include:
When we first meet a male patient with infertility concerns, we perform a complete medical and lifestyle workup to understand more about potential contributory factors. We will discuss stress, diet, exercise, and other markers that may be impeding proper sexual health. The psychological component of infertility should not be overlooked, so we will discuss those concerns.
Semen analysis. As a first step, a semen analysis is required. This involves getting a sample and analyzing semen and the sperm contained therein. We will be looking at several markers, including the volume of semen produced, the amount of sperm within it, the ability of the sperm to move properly, known as motility, and the shape or morphology of the sperm. Semen analysis is very straightforward and performed in our office. However, we will take multiple semen samples over a few weeks as levels can change over time.
Hormonal analysis. Our body is regulated by chemicals produced in various areas of the body known as hormones. High or low hormone levels can cause infertility, so checking these levels through simple bodily fluid tests is a quick way to understand if there are any problems. Most commonly, we check on follicle-stimulating hormone (FSH) and testosterone. Other hormones may be checked as well.
Urinalysis. We may test patients’ urine for white blood cells, a sign of infection in the body, and test for sperm in the urine, known as retrograde ejaculation.
Ultrasound and X-ray. Using diagnostic imaging tools, we can check to see if there are blockages that would limit the flow of sperm into the semen,
Biopsy. In some cases, a biopsy of the testes, removing a small piece of tissue, may be appropriate to understand how sperm are produced and if there is a problem on the testicular level.
Can You Test at Home?
Most of the advanced diagnostic testing will be performed at your urologist’s office or a lab. However, there are home test kits to check for sperm count problems. These tests can be very accurate and relatively easy to use. However, low sperm counts should be confirmed and ultimately diagnosed by an appropriate specialist. Remember that the causes of infertility are many and varied, so using only one marker may not give a complete and accurate picture.
Is Male Infertility Getting More Prevalent?
The short answer to this question is yes. It seems that fertility rates are declining in men. This also appears to be happening in women. The most likely cause of this decline is endocrine disruption which involves hormonal or chemical imbalances. Research has been done on hormone-disrupting chemicals, many of which have been popularized by Dr. Shanna Swan. Public awareness of what is in our food and the products we use is starting to increase, but slowly. Chemicals in just about everything we consume, like BPA, phthalates, and PFAs, may all contribute to this fertility decline. Sadly, health regulatory agencies have not caught up to this potential threat.
Is It My Partner?
As mentioned above, about 50% of infertility cases are caused by a man, and a woman causes the other half. Breaking it down further, approximately 1/3 of cases can be attributed to the woman, 1/3 to the man, and the final third represents issues associated with both partners. We typically suggest that both partners visit their respective reproductive health specialists to get a complete picture of what may be causing infertility and receive appropriate treatment. Dr. Kapadia works with his female reproductive health counterparts to develop a comprehensive treatment plan if one or both partners have a fertility problem.
The Bottom Line
Infertility is becoming more prevalent in modern society because of several modifiable and non-modifiable factors. Speaking to a qualified men’s health specialist is truly the best way to understand more about infertility and possible treatments. However, patients should be aware that pregnancy does not often happen on the first or second try, so they should not jump to conclusions and do not need to visit a specialist for about a year without any luck. It is also crucial that partners keep an ovulation calendar, as this can dramatically improve the chances of conception. Lastly, a healthier lifestyle can improve the quality of sperm and the chances of getting pregnant sooner.
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