The Importance of The Male Workup for Infertile Couples

Couples who experience infertility can become concerned and disappointed by a lack of conception. This frustration may lead to avoidance of an evaluation, but we encourage couples not to delay and pursue testing as soon as possible.

Our recommendation is for couples to continue attempts at conception for six months (if over the age of 35) to one year (for younger couples.) If they do not achieve success, we will commence an evaluation to discover and treat the causes of infertility. We know that it takes two to succeed. That’s why both partners must be evaluated, including the male partner.

Timely evaluation for both partners is crucial in addressing infertility.  Male factor infertility is a significant contributor to infertility affecting approximately 50% of infertile couples. Diagnosing and treating male factor infertility is imperative to increase the chances of a successful pregnancy.

The male partner requires a semen analysis, male hormones, and genetic testing for recessive diseases and screening for infectious diseases. Males constantly produce new sperm (spermatogenesis) every 90 days regardless of age. While sperm production continues in advanced aged males, sperm quality may deteriorate. Men can easily become sensitive to this evaluation and often avoid or delay this testing. Obviously, men are just as responsible for success as are the women. Therefore, the male evaluation should be performed concurrently with the female testing.

The infertility diagnosed in a couple is nearly 30-50% due to an exclusive male problem. The male issues can be:

• Hormonal imbalances such as thyroid, prolactin, or suppression of FSH.
• Physical injury to the testis/Undescended testicles
• Hernia repairs or other surgical injuries
• Chemotherapy or radiation
• Physical blockage of sperm delivery
• Lifestyle factors: smoking, alcohol, excessive stress or drug use (steroids/androgens)

A medical history and complete evaluation will provide information on serious medical conditions, hormonal imbalances, or genetic abnormalities. All results would be reviewed and discussed with the couple, including the semen analysis with specifics on concentration, motility, morphology, and total volume. Treatment for the male is focused on identifying the cause and proceeding with effective treatments. This will utilize medications or surgical techniques.

Hormonal problems in the male tend to lower the FSH and LH. These hormones stimulate the testicles to produce both sperm and testosterone. High TSH (hypothyroidism) or high prolactin will suppress FSH and lead to decreased sperm production. The use of testosterone or steroid substances will also cause a decrease in FSH and lead to low sperm counts. There are uncommon diseases such as Celiac (allergy to wheat) and Hemochromatosis (Excessive iron) that can also cause a similar suppression of FSH and male infertility.

Physical testicular injury or damage to the testicles from chemotherapy or radiation will lead to loss of the sperm-producing cells in the testicle (Sertoli Cells) and lead to the diagnosis of testicular failure, which is revealed by a high FSH result rather than low.

Men can experience damage to the vas deferens (the tube carrying sperm from the testicle to the penis) without an injury to the testicle itself. This occurs purposely after a vasectomy. However, some men have congenital absence of the vas deferens, or it may become obstructed by injury or infection. An absent vas deferens can be due to the male being a carrier of the cystic fibrosis gene or to having cystic fibrosis. Genetic testing for recessive diseases can reveal these genetic conditions. In addition, a karyotype and Y-chromosome micro-deletion testing is required when azoospermia (complete absence of sperm) is present.

It is important for the couple to support each other during their individual evaluations. Certainly, a thorough review of these factors is necessary for the male partner. Nonetheless, it is important to remember that there is no blame for the infertility, but rather an approach to resolve all apparent issues in the couple for resolution of the infertility.

At Damien Fertility Partners, we are on your family’s team every step of the way for support, encouragement, and expert care. Call us at 732-758-6511 or email hello@damienfertilitypartners.com and make an appointment to get evaluated by one of our experienced providers.