Patient education: Male infertility (The Basics)

Why might I be having trouble getting my partner pregnant? — For some people, pregnancy happens easily, while others have a harder time. There are different reasons why a couple might have trouble getting pregnant. For example, there could be a problem with 1 or both partners. When the problem is with the person who is trying to get their partner pregnant, this is called "male infertility." Doctors also sometimes use the term "male factor infertility."

To get a partner pregnant, you need to have a normal number of healthy sperm. Doctors call this a "normal sperm count." If you have infertility, you might have 1 of the following problems with your sperm:

●You have no sperm at all.

●You do not have enough sperm – This is called having a "low sperm count."

●You have unhealthy sperm – The sperm might move too slowly or have abnormal shapes.

There are many reasons why you could have an abnormal sperm count. These include:

●Problems in the testicles, such as a blockage in the vas deferens – The vas deferens is the tube the sperm travels through to reach the penis (figure 1). Sometimes, a blockage is caused by a past infection.

If you had a vasectomy in the past, your vas deferens was intentionally cut or blocked. A vasectomy is surgery done to prevent the ability to get a partner pregnant. After a vasectomy, you cannot get another person pregnant unless you have a procedure to reverse it.

●Having low levels of the hormone testosterone

●Certain genetic problems some people are born with

But most of the time, doctors cannot find a specific reason for having an abnormal sperm count.

When should I see a doctor? — In most cases, doctors recommend testing if a couple cannot get pregnant after having unprotected sex for 1 year. At that time, both partners are often tested. But if you are worried, talk with your doctor or nurse. They might recommend that you have tests done sooner. If your partner is older than 35 and has not gotten pregnant after 6 months of trying, your doctor will start tests at that time.

What tests will I have? — Your doctor will order a test called a "semen analysis" to check your sperm. This test can check how many sperm you make and how healthy they are. For this test, you need to provide a sample of your sperm.

If your sperm count is low, your doctor will repeat the test 1 or more times. If the results are still abnormal, your doctor might do other tests. For example, they might do:

●Blood tests

●An exam to measure the size of your testicles

●Tests to see if there is a block in your testicles

What treatments are available? — Different treatments can improve the chances that you will be able to get your partner pregnant. These can include:

●Hormone treatment to increase sperm counts – If your hormone levels are low, this can be treated with hormone shots.

●Surgery to open up a block in the testicle – For example, if you had a vasectomy in the past, you can have surgery to reopen the tube that sperm travels through.

●In vitro fertilization ("IVF") – During IVF, a doctor takes eggs from your partner's ovaries (figure 2). The eggs are put in a laboratory dish with your sperm so the sperm can fertilize 1 or more of them. Then, the fertilized egg is put into your partner's uterus to hopefully grow into a pregnancy.

Many times, a doctor will do a treatment called "intracytoplasmic sperm injection" ("ICSI") along with IVF. During ICSI, a doctor takes only 1 sperm and injects it into the egg. IVF with ICSI might be used if you have a low sperm count or abnormal sperm. But this treatment might also be an option if you have no sperm in your sample. This is because you might still have sperm in your testicles that a doctor can take out and use for the procedure. If this is not an option for you, you and your partner might try using "donor" sperm from another person, such as sperm from a sperm bank.

Do treatments always work? — No. Treatments do not always help a couple get pregnant. The same treatment might help 1 couple get pregnant, but not another.

How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you and your partner, think about:

●How well your doctor thinks the treatment will work

●Cost – Health insurance pays for treatments in some states, but not all.

●How long your doctor thinks the treatment will take

●Downsides of the treatment

You should also talk with your doctor about other options for having children, such as adoption.

These decisions can be difficult. You might find it helpful to talk to a counselor or go to a support group for people who are having trouble getting pregnant.

More on this topic

Patient education: Infertility in couples (The Basics)
Patient education: Female infertility (The Basics)
Patient education: Androgen replacement in men (The Basics)

Patient education: Evaluation of infertility in couples (Beyond the Basics)
Patient education: In vitro fertilization (IVF) (Beyond the Basics)
Patient education: Ovulation induction with clomiphene or letrozole (Beyond the Basics)
Patient education: Infertility treatment with gonadotropins (Beyond the Basics)