Male Infertility

A successful pregnancy starts with both healthy eggs and sperm. When infertility issues are encountered and there is a male partner involved, it is critical that he be thoroughly assessed. When male factors, such as low sperm count or a blockage that is preventing sperm delivery, account for a couple's infertility, it is called male infertility or male factor infertility. There are several treatments available for male infertility.  

What Causes Male Infertility?

Approximately 30 percent of all cases of infertility are the result of male factors, including the following:

• Low or absent sperm production: Without proper numbers of healthy sperm, the chance of fertilization is decreased.
• Erectile dysfunction: The inability to achieve and/or maintain erection can be a barrier to conception.
• Abnormal sperm function: Sperm must have proper motility and the ability to penetrate the egg.
• Varicocele: This is a condition in which varicose veins develop around the testes. It is a very common and may contribute to male factor infertility. Varicocele can be treated by a urologist with surgery or fertility treatments can be attempted prior to surgery.
• Lifestyle: Use of recreational drugs (i.e., marijuana, cocaine), heavy alcohol use, cigarette smoking, certain medications, and excessive heat to the genital area (like hot tubs) can affect sperm quality and function.
• Hormonal disorder: Improper male hormone function can affect sperm production and fertilization ability.
• Chromosomal defects : Chromosomal abnormalities, specifically translocations and deletions on the Y chromosome, are associated with male infertility.
• Birth defects: Abnormalities in a man’s reproductive system can occur during fetal development. An obstruction or blockage of the vas deferens can prevent sperm from reaching the ejaculate.
• Iatrogenic: Vasectomy is a permanent form of contraception but it can be reversed by a urologist or sperm can be retrieved surgically.
• Immunological problems: A man may have antisperm antibodies (immune or protective proteins), which attack and destroy sperm after a vasectomy.

How Is Male Infertility Diagnosed?

When male factor infertility may be contributing to a couples' fertility struggles, the male partner will first undergo a semen analysis. A semen analysis evaluates characteristics of the semen and the sperm contained within it. The sperm is analyzed for count (how many are produced), motility (how well they “swim”), and morphology (their size and shape). Male partners will be asked to undergo a semen analysis as preliminary testing before infertility treatment is initiated. Sperm parameters can fluctuate, so additional semen analyses may be needed to confirm the initial assessment.

How Is Male Infertility Treated?

Once it has been determined that male factors are affecting one’s fertility, Columbia University Fertility Center offers the following procedures:

• Intracytoplasmic sperm injection (ICSI): Most problems involving male factor infertility can successfully be resolved by the use of ICSI. ICSI is used in conjunction with IVF and is a procedure in which the sperm is directly injected into the egg in a laboratory setting. The fertilized egg then grows in the laboratory for up to seven days, after which it is transferred to the woman’s uterus or frozen for future use. ICSI can potentially eliminate barriers to fertilization such as low sperm count, less mobile sperm or a reproductive tract blockage.
• Testicular sperm extraction or aspiration (TESE/TESA): Testicular sperm extraction (TESE) is the process of removing a small portion of tissue from the testicle in the hopes of extracting viable sperm cells for ICSI. With testicular sperm aspiration (TESA), the tissue and extracted sperm are aspirated from the testicle. Performed under anesthesia and coordinated with a urologist, the TESE or TESA process is recommended to men who are unable to produce sperm by ejaculation as a result of primary testicular failure, congenital absence of the vas deferens or non-reconstructed vasectomy.
• Further evaluation: One of the many advantages of being the fertility practice of Columbia University Irving Medical Center is the wealth of additional medical and interdisciplinary expertise available. This affords our patients the benefit of collaboration among top-notch specialists when necessary. For cases where a more comprehensive assessment of the male partner is needed, we are pleased to offer urology services for continuity of care. Peter Stahl, MD, Director of Male Reproductive & Sexual Medicine, is available to see patients at multiple locations, including in midtown and northern Manhattan.