Male infertility is a result of:
Abnormal semen production or volume
Decreased or absent sperm in semen
Abnormal sperm motility or morphology
Blockages that prevent the delivery of sperm
Conditions such as illnesses, chronic health problems, injuries, lifestyle and other factors can also play a role in male infertility.
No matter the cause, not being able to conceive a child is frustrating. Help and answers are available. Start by scheduling an appointment for a semen analysis with us or your doctor as soon as possible.
Men can have a totally normal libido, normal physical characteristics, normal strength or outwardly look very virile, yet their sperm numbers can be decreased or sperm function can be decreased.
There are some cases of male infertility where there are hormonal causes and so men may have signs of "low T.”
In some cases, an underlying problem such as an inherited disorder, a hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm can lead to signs of male infertility.
Having intercourse just once a month or once every couple of weeks is not optimal for fertility. If you're not having intercourse very often, start by increasing the frequency. More frequent sex — especially during the middle of the cycle — will help.
You don't have to have sex on the same day that your wife is ovulating. In general, given normal sperm and a normal female reproductive tract, sperm can survive in the woman's cervix for up to five days.
No sperm or not enough sperm production. Normal sperm count is defined as 15 million sperm or more per milliliter of ejaculated semen. A sperm count lower than 15 million can cause problems with a man’s fertility.
Abnormalities with a man’s testicles such as an undescended testicle or varicolceles (swollen veins) or the absence of the movement of the sperm from the testicle to the urethra can lead to a lower sperm count.
Low sperm motility. The percentage of sperm that are able to move in an ejaculated sample is known as sperm motility. Normal sperm motility, as defined by the World Health Organization (WHO), is when more than 40% of sperm are moving.
Problems with the delivery of sperm as a result of sexual problems. This could be due to premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage outside the testicle; or damage or injury to the reproductive organs.
Sexual dysfunction is not uncommon.
There are many physical and psychological factors that can contribute to decreased libido or erectile dysfunction. This can lead to difficulty in getting pregnant. Many guys can benefit from a medical consultation to diagnose and correct the cause.
Most medical professionals would consider about age 40 to be advanced paternal age, and that is when issues can occur both with sperm quality and some risks to the offspring.
Sperm quality. Unlike women, who are born with all the eggs they will ever have, men typically will produce sperm throughout their lifetime. This has its advantages and its disadvantages. Men typically don’t run out out of sperm, but the quality degrades over time. Sperm production is much like making a photocopy of a photocopy of a photocopy.
Risks to offspring. Ultimately this lowering of sperm quality can translate to errors in the genetic sequence in the DNA, and that can lead to issues with some potential increase for genetic disorders in the offspring. The risk is not high, but it's more prevalent as men get older.
Certain conditions or influences can increase a man’s risk for infertility.
Using certain illicit drugs
Low testosterone treatments
Being severely depressed or stressed
Having certain past or present infections
Being exposed to toxins
Overheating the testicles
Having experienced trauma to the testicles
Having a prior vasectomy or major abdominal or pelvic surgery
Having a history of undescended testicles
Being born with a fertility disorder or having a blood relative with a fertility disorder
Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
Taking certain medications or undergoing medical treatments, such as surgery or chemotherapy or pelvic radiation used for treating cancer
A semen analysis is an important part of the work-up for infertility.
It only takes one sperm to fertilize an egg, but the way a man’s reproductive system works, nearly all of the sperm die in the woman's vagina. It's been estimated that in humans only about one in a million sperm is able to swim from the vagina through the cervix, through the uterus, up into the fallopian tube where it will likely contact an egg.
Total count. The total number of sperm in the semen sample.
Volume. How much semen a man produces.
Concentration. The number of sperm in each milliliter of semen. The semen will ideally have at least 15 to 20 million sperm per cubic centimeter.
Motility. The percentage of sperm that are moving. If a sperm is not moving, or is moving slowly, it may not be able to get to the egg or penetrate the barriers around it.
Morphology. Whether the sperm are the right shape.
Sperm DNA fragmentation. Damage to the sperm DNA can cause infertility and miscarriage.
Our Andrologists perform semen analyses in our office and the results are available in approximately one hour.
In preparation for a semen analysis, you will be asked to refrain from ejaculation for 2 to 5 days. You should collect the specimen in a sterile collection container, preferably one you have received from CARE Fertility, as these have been tested for toxicity.
Please label your container with your name and date of birth.
Collection of the entire specimen is important. Notify the Andrologist if any portion is not collected.
Your specimen should be delivered to CARE Fertility within one hour of collection. During transport, do not attempt to heat or cool the specimen.
You have the option to collect at home or at our center.
Sometimes a patient will express concerns over various things after collection. For example, many men may be concerned about the size of their sample. Normal volume is 2-8 mL or ¼ - 1.5 teaspoon.
Typically, we expect to see about half of the sperm moving, with about a quarter of the sperm moving rapidly with a good progressive swimming ability — those sperm are likely to be functional.
Semen analysis is a great tool, but it's not a perfect predictor for fertility. Sometimes a patient can have relatively low sperm numbers and still get his female partner pregnant. Ultimately, it only takes one sperm to fertilize an egg! But it’s also true that men can have good semen parameters, with great sperm counts and sperm movement, and still be infertile.