Male Infertility:
Coordinated Care for a Shared Concern
Jay Sandlow, MD
Medical College of Wisconsin Urologist;
Vice Chairman, Urology
A common misconception about infertility is that it is a woman's problem. But in fact, infertility affects men and women equally. Jay Sandlow, MD, a specialist in the treatment of male infertility, explains its common causes and stresses the importance of coordinated care for both partners.
Q. How prevalent is male infertility?
In close to half of all couples experiencing problems with infertility, a male factor will be involved. In those cases, it's most often strictly related to the male, but it can also be a combined male/female factor. So in all infertility cases, it's just as likely there is a problem with the man as with the woman. That's why our Reproductive Medicine Clinic physicians and staff always see a couple together. Men and women go through a medical exam and history and then, through our coordinated team approach, we plan treatment specifically tailored to the couple's situation. It's less expensive and less invasive to do a complete work up on the man, so by having the male partner involved right from the start, we can save the couple time and money.
Q. What are the most common causes of male infertility?
The primary causes of male infertility are impaired sperm production and impaired sperm delivery.
The most common reason a man may experience impaired sperm production is because he has a varicocele. A varicocele is a mass of dilated veins in or around one testicle or both. These veins can increase the temperature of the testes, and the increased heat can damage or destroy sperm. Approximately 40 percent of men seeking infertility treatment have a varicocele. However, although 10 to 15 percent of all men have a varicocele, most are not going to experience fertility problems. As a result, we cannot always be certain the varicocele is the only contributing factor to a man's infertility. A varicocele can be corrected through simple outpatient surgery and it is a step we may take, depending upon other factors in the couple's situation.
Hormone dysfunction that can result in testosterone deficiency can also impair sperm production. This is seen in less than five percent of men with infertility and can be treated through medication. Impaired sperm delivery is usually due to an obstruction or blockage in the vas deferens, the duct that carries sperm from the body, and occurs in about 15 percent of infertile men. An infection in the testes is the most common cause, but a blockage can also result from other causes, such as prior hernia surgery. Most blockages can be repaired through surgery.
Sperm delivery can also be a serious problem for men who carry the gene mutation for cystic fibrosis. These men do not have the disease, but 80 percent who have the gene are born without a vas deferens and are sterile. This gene is fairly common – in the Caucasian population, approximately 1 in 25 are carriers. In these cases, sperm can be harvested from the man's testicles and be used for in vitro fertilization. However, the couple would want to go through genetic counseling to determine if the woman also is a carrier. There are other more rare chromosomal abnormalities that contribute to male infertility, and similar treatment techniques can be used, but must always involve genetic counseling, which we provide at Froedtert & the Medical College of Wisconsin.
We cannot always determine what is causing male infertility. In these cases we rely on empiric therapy, meaning we may try different approaches, such as medication to encourage sperm production, to see if it has any effect.
Q. Can a man's lifestyle affect his fertility?
Certain factors can affect sperm production, such as the use of tobacco or street drugs like marijuana and cocaine, and excessive consumption of alcohol. Hot tub use can cause the testicles to overheat, so I recommend limiting hot tub use to once a month. We don't have any firm evidence that stress affects male fertility, but obviously, for overall health, it's wise to keep stress in check. We do know underwear – boxers versus briefs – makes no difference at all. That's just a myth.
Any man considering a lifestyle change to improve his fertility needs to know that it takes at least three months to see any effect, because that's how long it takes to make new sperm. You can't just make a temporary change, because it won't work.