Many infertile couples have more than one cause of infertility, so it's likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified.
Infertility tests can be expensive and might not be covered by insurance — find out what your medical plan covers ahead of time.
Diagnosing male infertility problems usually involves:
- General physical examination and medical history. This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
Semen analysis. Semen samples can be obtained in a couple of different ways. You can provide a sample by masturbating and ejaculating into a special container at the doctor's office. Because of religious or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, semen can be collected by using a special condom during intercourse.
Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.
Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
- Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
- Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems also might contribute to infertility. A blood test measures the level of testosterone and other hormones.
- Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
- Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
- Testicular biopsy. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal, your problem is likely caused by a blockage or another problem with sperm transport.
- Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change recommendations for treatment.
- Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Often, an exact cause of infertility can't be identified. Even if an exact cause isn't clear, your doctor might be able to recommend treatments or procedures that will result in conception.
In cases of infertility, the female partner also is recommended to be checked. This can help to determine if she will require any specific treatments or if proceeding with assisted reproductive techniques is appropriate.
Treatments for male infertility include:
- Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
- Treating infections. Antibiotic treatment might cure an infection of the reproductive tract, but doesn't always restore fertility.
- Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
When treatment doesn't work
In rare cases, male fertility problems can't be treated, and it's impossible for a man to father a child. Your doctor might suggest that you and your partner consider using sperm from a donor or adopting a child.
Lifestyle and home remedies
There are a few steps you can take at home to increase your chances of achieving pregnancy:
- Increase frequency of sex. Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
- Have sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
- Avoid the use of lubricants. Products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.
Evidence is still limited on whether — or how much — herbs or supplements might help increase male fertility. None of these supplements treats a specific underlying cause of infertility, such as a sperm duct defect or chromosomal disorder. Some supplements might help only if you have a deficiency.
Supplements with studies showing potential benefits on improving sperm count or quality include:
- Black seed (nigella sativa)
- Coenzyme Q10
- Folic acid
- Horse chestnut (aescin)
- Panax ginseng
Talk with your doctor before taking dietary supplements to review the risks and benefits of this therapy, as some supplements taken in high doses (megadoses) or for extended periods of time might be harmful.
Coping and support
Coping with infertility can be difficult. It's an issue of the unknown — you can't predict how long it will last or what the outcome will be. Infertility isn't necessarily solved with hard work. The emotional burden on a couple is considerable, and plans for coping can help.
Planning for emotional turmoil
Set limits. Decide in advance how many and what kind of procedures are emotionally and financially acceptable for you and your partner, and determine a final limit. Fertility treatments can be expensive and often aren't covered by insurance.
A successful pregnancy often depends on repeated attempts. Some couples become so focused on treatment that they continue with fertility procedures until they are emotionally and financially drained.
- Consider other options. Determine alternatives — adoption or donor sperm or egg — as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness if conception doesn't occur.
- Talk about your feelings. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief if treatment fails.
Managing emotional stress during treatment
- Practice stress-reduction techniques. Examples include yoga, meditation and massage therapy.
- Consider going to counseling. Counseling such as cognitive behavioral therapy, which uses methods that include relaxation training and stress management, might help relieve stress.
- Express yourself. Reach out to others rather than holding in feelings of guilt or anger.
- Stay in touch with loved ones. Talking to your partner, family and friends can be helpful.
Preparing for your appointment
If you have never been evaluated by a doctor, you might begin by seeing your family doctor. If, however, you have a known condition resulting in infertility or have any abnormalities on your testing by your primary care doctor, then you may be referred to a specialist.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. If a semen analysis is scheduled, you will need to refrain from ejaculating for at least two and no longer than 11 days prior to the collection.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Find out whether you have a family history of fertility problems. Having a male blood relative, such as your brother or father, with fertility problems or other reproductive issues might give clues to the cause of fertility problems.
- Find out from your parents if you had undescended testes or other issues at birth or in early childhood.
- Make a list of all medications, vitamins and supplements that you're taking. This includes prior use of muscle-building substances and any use of alcohol, tobacco, marijuana or other recreational drugs.
- Take your partner along. Your partner also might need tests to see whether she has any fertility problems that could be preventing pregnancy. It's also good to have your partner along to help keep track of any instructions your doctor gives you or to ask questions you may not think of.
- Write down questions to ask your doctor.
Questions to ask your doctor
- What do you suspect might be interfering with my ability to father a child?
- Other than the most likely cause, what are other possible reasons my partner and I haven't been able to conceive a child?
- What kinds of tests do I need?
- Will my partner also need tests?
- What's the best treatment for my condition?
- What are the alternatives to the primary approach that you're suggesting?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
Don't hesitate to ask questions at any time during your appointment.
What to expect from your doctor
Be ready to answer questions your doctor is likely to ask, including:
- At what age did you start puberty?
- Have you had any sexual problems in this relationship, including difficulty maintaining an erection, ejaculating too soon or not being able to ejaculate?
- Have you ever fathered a child?
- Have you had a vasectomy or other abdominal, pelvic or scrotal surgery?
- Do you use illicit drugs, such as marijuana, cocaine or anabolic steroids?
- Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
- Are you currently taking any medications, including dietary supplements?
- Do you have a history of undescended testicles?
Sept. 20, 2018