Male infertility

Diagnosis

Diagnosis of infertility often involves both partners. It might take some tests to find the cause of infertility. Sometimes, no cause is found.

Diagnosing male infertility issues most often involves:

• Physical exam and medical history. Besides looking at your genitals, your healthcare professional asks about any conditions that affect your family, long-term health conditions, injuries or surgeries that could affect fertility. Be ready to answer questions about your sex life, whether you've fathered children in the past, and about your puberty.

• Semen analysis. You can give a semen sample by masturbating and ejaculating into a special container at a medical office. Some people prefer using a special condom during sex at home to collect a sample.

  Your semen then goes to a lab to measure the number of sperm present and look for any issues with the sperms' shape, called morphology, and movement, called motility. The lab also checks your semen for signs of infection or other issues.

  Sperm counts often change from one sample to the next. So you may have several semen analysis tests done over time to make sure the results are correct. If your sperm analysis is typical, your healthcare professional may suggest testing your partner before you have any more tests.

Other tests can help find the cause of your infertility. These can include:

• Scrotal ultrasound. This test uses sound waves to make images inside your body. A scrotal ultrasound can show if there is a varicocele or other issues in the testicles or around them.
• Transrectal ultrasound. A healthcare professional puts a small, lubricated wand into the rectum to check your prostate and look for blockages of the tubes that carry semen.
• Hormone testing. Hormones that the pituitary gland, hypothalamus and testicles make are vital to fertility. Issues in other hormonal or organ systems also might be part of infertility. A blood test measures the level of testosterone and other hormones.
• Post-ejaculation urinalysis. Sperm in your urine can show that sperm are traveling backward into the bladder instead of out your penis during ejaculation. This is called retrograde ejaculation.
• Genetic tests. Changed genes can be a cause of very low sperm count. A blood test can show small changes in the Y chromosome. Genetic testing can diagnose conditions that were present at birth, called congenital, or passed through families, called inherited.
• Testicular biopsy. This test involves removing tissue samples from the testicle with a needle. If the results of the testicular biopsy show that you're making sperm as expected, you likely have a blockage or another issue with sperm getting to where it needs to go.

Treatment

Often, healthcare professionals can't find the exact cause of infertility. But even without an exact cause, there may be treatments for you that lead to your partner getting pregnant.

For most couples, both partners need to be checked. There may be treatments your partner needs, as well. Or you may learn that certain treatments won't work for the two of you.

Treatments for male infertility include:

• Surgery. For instance, surgery often can correct a varicocele or repair a blocked vas deferens. Surgery can reverse vasectomies. When there are no sperm in the ejaculate, sperm retrieval surgery often can get sperm from the testicles, epididymis or bladder in people whose sperm goes into the bladder instead of out the penis.
• Treating infections. Antibiotic treatment may cure an infection of the reproductive tract. But it doesn't always bring fertility back.
• Treatments for issues with having sex. Medicines or counseling can help conditions that affect fertility, such as ED or ejaculating too soon.
• Hormone treatments and medicines. Hormone replacement or medicines might help with infertility caused by high or low levels of certain hormones or issues with the way the body uses hormones.

• Assisted reproductive technology (ART). ART treatments involve getting sperm through ejaculation, surgery or from a donor. A healthcare professional then puts the sperm into the female partner.

  A healthcare professional also can mix the sperm with an egg in a lab, called in vitro fertilization. Or a healthcare professional can put a sperm into an egg, called intracytoplasmic sperm injection.

When treatment doesn't work

Rarely, there's no treatment for male fertility problems. For you to have a child, your healthcare professional might suggest that you and your partner think about using sperm from a donor or adopting a child.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

There are a few steps you can take at home to increase your chances of causing pregnancy:

• Have sex more often. Having sex every day or every other day beginning at least five days before your partner releases an egg, called ovulation, raises your chances of getting your partner pregnant.
• Time your sex. Pregnancy is most likely when the female releases an egg, called ovulation. This happens in the middle of the menstrual cycle, between periods. Sperm can live for a few days. So have sex 5 to 7 days before the date of ovulation and until two days after ovulation.
• Don't use lubricants. Products such as Astroglide or K-Y jelly, lotions, and spit might keep sperm from moving and working as they should. Ask your healthcare professional about sperm-safe ways to make the vagina moist.
• Live a healthy lifestyle. Eat healthy foods, stay at a healthy weight, get enough sleep, and exercise most days.
• Don't do things that harm health. Stop or limit your use of alcohol, quit smoking, and don't use illicit drugs.

Alternative medicine

Some studies show that the following herbs or supplements may help male fertility by improving sperm count or quality.

• Coenzyme Q10.
• Folic acid and zinc combined.
• L-carnitine.
• Selenium.
• Vitamin C.
• Vitamin E.

Talk with your healthcare professional before taking dietary supplements for male infertility. There's no good proof that they work, and some supplements may cause side effects or affect other medicines you take.

Coping and support

Coping with infertility can be hard. You can't know how long it will last or what the outcome will be. It brings up many feelings for couples. Plans for coping may help.

Planning for ups and downs

• Set limits. Fertility treatments can be costly and often insurance doesn't cover them. Decide as a couple how many and what kind of procedures you think you can handle. How much are you willing to spend? Talk about how you'll deal with the feelings the process brings up.
• Take a break. Sometimes it may help to stop treatment for a few months, then try again.
• Think about other choices. What else might you do? Use a donor sperm or egg? Adopt? Thinking about this early in the process may relieve some of the worry during treatments and help with loss of hope if treatments don't work.
• Talk about your feelings. Find support groups or counseling services for help before and after treatment. These may help you get through the process and help with grief if treatment fails.

Managing stress during treatment

• Try ways to reduce stress. These might include yoga, meditation, deep breathing or massage therapy.
• Think about getting counseling. Counseling such as cognitive behavioral therapy might help you relax and manage stress.
• Talk to others. Reach out to others rather than holding in the feelings the process brings up.
• Stay in touch with loved ones. Talking to your partner, family and friends can be helpful.

Preparing for your appointment

You might start by seeing your main healthcare professional. If you have a known condition that causes infertility or have had tests that showed fertility issues, your healthcare professional may send you to a specialist.

Here's some information to help you get ready for your appointment.

What you can do

• Ask what you need to do before the appointment. For instance, if you're having a semen analysis, don't ejaculate for at least 2 to 5 days before it's time to collect the sperm.
• Take your partner with you. Your partner also may need tests to check for fertility issues. And your partner can help keep track of information your healthcare professional gives you or have questions you may not think of.
• Find out what your medical plan covers before you have infertility tests. Infertility tests can be costly, and your insurance may not cover them.

Make a list of:

• All medicines, vitamins and supplements you take and their dosages. This includes muscle-building substances and alcohol, tobacco, marijuana or other illicit drugs.
• Male family members who had fertility issues. This includes brothers or fathers.
• Write down questions to ask your healthcare professional.

Questions to ask your doctor

Basic questions to ask include:

• What might be causing my infertility?
• Other than the most likely cause, what are other possible reasons my partner and I haven't been able to have a child?
• What tests do I need?
• Will my partner also need tests?
• What treatments are there for my condition?
• Should I see a specialist?
• Are there brochures or fact sheets that I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Be ready to answer questions such as:

• At what age did you start puberty?
• Have you had issues with sex with this partner, such as trouble getting and keeping an erection, ejaculating too soon, or not being able to ejaculate?
• Have you ever fathered a child?
• Have you had a vasectomy or other belly, pelvic or scrotal surgery?