SpringCreek Fertility Blog

Male Infertility 101

By Drs. Jeremy & Lorie Groll • Posted on November 9th, 2017

Guys, these next couple of blogs are devoted 100% to you! Sometimes it might seem like you are forgotten about when it comes to infertility, buy why? 40% of infertility cases are due to male factors and about 10% of infertility cases are due to a combination of male and female factors.

Let’s start with a brief overview of the male reproductive system. Sperm is the male gamete that is involved in creating life. Testosterone is a hormone that stimulates the production of sperm. The sperm are made in the testicles, move through the seminiferous tubules, into the epididymis where they are stored until they are ejaculated. The sperm mature while they are traveling through the male reproductive tract. During ejaculation the sperm then travels from the epididymis through the vas deferens combining with seminal fluid to create semen and then out of the urethra. In other words, the sperm must travel a distance to get to the egg, the female gamete. Interestingly enough, the average man produces more than 15 million sperm per milliliter however only a few hundred thousand make it into the uterus.

Many factors can affect the sperm:
• Genetic abnormalities such as Y microdeletions, in which a piece of the Y chromosome is missing from the DNA
• Anatomic abnormalities such as varicoceles (enlargement of veins in the spermatic cord), congenital absence of the vas deferens (associated with cystic fibrosis gene mutations), or other obstructions anywhere in the long, complicated tract leading from sperm production to ejaculation
• Hormonal problems such as low testosterone, low thyroid function, and high prolactin hormones
• Neurological problems, which can lead to erectile and ejaculatory dysfunction
• Anabolic steroid use, especially testosterone replacement
• Environmental factors including alcohol, tobacco, illicit drugs, lubricate used, and high heat from hot tubs.
• Cancer treatment, preservation prior to treatment is available

Male infertility is typically assessed by semen analysis. A man’s likelihood of impregnating a woman is dependent on many things, here are a 4 main factors evaluated:

  1. Concentration (number of sperm present). A normal concentration is at least 15 million sperm per milliliter (mL). Problems with sperm count may be identified as azoospermia (no sperm in the semen), oligospermia (not enough sperm in the semen, fewer than 15 million per ml.), or severe oligospermia (fewer than 5 million per ml.).
  2. Motility (number of sperm moving forward). At least 40 percent should have progressive motility.
  3. Morphology (the shape of the sperm). At least 4 percent should be normally formed. Fewer than this is a condition called teratospermia. Irregular morphology includes sperm with an overly large head, two heads, or kinked or curly tails, for example.
  4. DNA fragment index (DFI). The DFI looks at damage done to the sperm after production. This analysis is separate from a semen analysis. An abnormal DFI correlates to reduced pregnancy outcomes for natural and IUI attempts and also is correlated to increased miscarriage risk.

A man with a low sperm count should see a doctor to assess the possibility of these abnormalities. Many are correctable and temporary, whereas others are permanent. However, in most cases there is no identifiable cause for a low sperm count. Sperm counts can fluctuate quite a bit over time, so a single test revealing a low sperm count doesn’t have to be the final word.

Although more than 100 million sperm are typically ejaculated, only about 40 survive through the two hour trip to the vicinity of the egg. Therefore, when the baseline number is halved, there is much less possibility that a single sperm will complete the arduous journey. However, it’s likely that the quality (motility and shape) of the sperm is more important than the overall count. A sperm’s job is to swim fast and straight. If it can do that, it has a chance of winning the race to the egg.

The Bottom Line: Many causes of male infertility are treatable! Talk to your doctor, have the difficult conversation, understand what is happening to your body, and make the necessary changes. You are not alone, we are rooting for your success!

Source: Fertility Foods, written by Jeremy Groll, MD, and Lorie Groll

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