Treating Male Infertility
Apr 25, 2022 Rosanna Turner
Infertility is more common than many realize. About one in five women of childbearing age (15-49) are unable to get pregnant after trying for a full year, according to the Centers for Disease Control and Prevention. Data also shows that infertility affects 8% to 12% of couples globally.
However, infertility is not exclusive to women. In 50% of couples, a male factor is the primary or contributing cause of infertility.
Dr. Ariel Moradzadeh, a urologist at Cedars-Sinai, says that he often sees couples who have been trying to conceive for more than a year, but the male partner has yet to be evaluated for any possible infertility issue or low sperm count.
"Some people wrongly blame the female, but almost half of the time, it's the male factor affecting a couple's ability to conceive," he says. "Men should be evaluated for infertility, too, and sooner than they often are."
"When a couple is having trouble conceiving, it could be that either of the two partners' infertility issues play a role."
Understanding male infertility
As a male infertility specialist, Dr. Moradzadeh focuses on optimizing male fertility. In males, the cause of infertility goes beyond low sperm count. Along with having a low concentration of sperm, contributing factors of infertility include low sperm motility, lack of forward-moving sperm, or abnormally shaped sperm.
This means that a man could not have enough sperm, the sperm could not be moving forward to reach the egg or the sperm could be the wrong shape, which will impair the sperm's ability to fertilize the egg.
The phenomenon of sperm production
Another factor that contributes to male infertility is something called "semen volume," says Dr. Moradzadeh.
"The liquid in the male's semen becomes the carrying vehicle, enabling the sperm to get to the cervix and fertilize the egg," he explains. "Some males don't have enough liquid to carry the sperm."
Additionally, some men have varicocele, a condition in which the veins around the testicle are enlarged. This causes blood to be trapped and generates heat in the area, which impairs sperm production and quality.
"Sperm quality and production relies on the environment inside and around the testicles," Dr. Moradzadeh says.
"Sperm are temperature sensitive, and it's about 1 degree Celsius cooler outside the body than inside. This is why testicles in the male are outside the body, compared to ovaries in the female, which are inside the body."
Physicians can surgically repair the varicocele to improve sperm quality.
Lifestyle factors that affect male infertility
For men, certain health and lifestyle behaviors can affect sperm production and quality.
Dr. Moradzadeh says that excessive alcohol consumption, marijuana use and anabolic steroid use can contribute to male infertility.
"I talk to men about the importance of marijuana cessation when trying to conceive, minimizing alcohol consumption around the time of conception, and how abusing opioids has a direct effect on testosterone and sperm production," he says.
In regards to anabolic steroid use, Dr. Moradzadeh says that men who abuse steroids don't always consider the long-term impact this has on sperm production. After men stop using steroids, it can take over a year for them to recover sperm production, and in some cases, it doesn't recover at all.
Is male infertility treatable?
Following an evaluation, there are steps men and fertility specialists can take to address male infertility and sexual dysfunction.
Hormones are a factor in male fertility, specifically the pituitary gland.
"There are medications I can prescribe to male patients that help stimulate the pituitary gland, signaling the testicles to make more sperm and testosterone," Dr. Moradzadeh says.
Educating men and couples about lifestyle behaviors that can affect fertility—like drinking, smoking and using marijuana—also can increase one's chances of conception.
One thing that many couples don't understand is that the sperm and fluid a male ejaculates today was actually made 71-74 days ago, Dr. Moradzadeh says.
"Sperm production is typically a 74-day process," he says. "Whatever treatment or adjustments we make, males won't see the benefit in sperm quality for another two-and-a-half months. In that sense, it's a slow process."
How both partners play a role in fertility
For couples in which both partners are in their late 30s or early 40s, it's important to understand the cumulative effect that environmental and lifestyle factors can have when it comes to fertility in both men and women.
"When a couple is having trouble conceiving, it could be that either of the two partners' infertility issues play a role," Dr. Moradzadeh says.
"On the male side, there's not enough discussion, education and awareness about how lifestyle factors impact sperm production and quality."