Published November 02, 2023
The most efficient way for couples to receive support and treatment for infertility is to have both men and women evaluated for potential causes, yet women often remain at the center of the conversation. Out of the 15% of couples unable to get pregnant after a year, male factor infertility can impact up to 50% of those cases.
To help determine the best course of action, female patients should see a reproductive endocrinologist, while male patients would benefit from seeing a reproductive urologist. These specialists can conduct the appropriate testing to determine potential causes of infertility, create a game plan for next steps and evaluate their overall health.
According to Lawrence + Memorial Urologist Katherine Rotker, MD, assistant professor at Yale School of Medicine, there are generally two categories of male factor infertility. One category has to do with the patient’s sperm. Sometimes the concentration can be low, movement or motility is abnormal, or there could be issues with sperm morphology or shape.
Another major cause of male factor infertility has to do with a blockage or obstruction, due to things like infections or prior surgeries.
Testing for male patients is less invasive than the testing required of female patients and usually only includes a sperm analysis and blood work to look at things like testosterone levels and genetic conditions that could impact fertility.
“Sometimes I will uncover other health issues that haven’t been diagnosed in the past,” said Dr. Rotker. “I see my role as not only for evaluating fertility but looking into that patient’s overall health, making sure we’re not missing anything.”
Common risk factors associated with male factor infertility can include:
“If there’s ever a time to be living our healthiest lifestyle, it’s when we are trying to conceive. There’s some data to suggest outcomes even in your child’s future health can be affected by the current health of both partners,” said Dr. Rotker.
“Men generally do not talk to each other about male factor fertility or infertility issues. In addition, the media focus tends to have a slant or bias towards the female side, instead of looking at the couple as an entity,” said Bridgeport Hospital Urologist Matthew Wosnitzer, MD. “We try to just dispel it right out of the gate, I tell them, ‘You're not the only one.’”
Dr. Wosnitzer says when talking with patients for the first time one common misconception they have is there’s no treatment for infertility, but that’s simply not true. Blockages can be treated with microsurgical procedures such as a vasectomy reversal and sperm extraction. Sperm extraction requires assisted reproductive techniques such as invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), in which sperm is injected into an egg.
Patients with hormonal abnormalities such as low testosterone, which can impact sperm, may benefit from medication. However, patients concerned about their fertility should not take over the counter testosterone supplements or standard testosterone replacement, which can work like a male birth control. Instead, there are specific medications designed to improve testosterone levels while preserving fertility that should only be prescribed and monitored under the direction of a urologist.
In addition to medical interventions, couples may benefit from mental health support to deal with the toll that infertility can take.
“Studies suggest that men may internalize fertility struggles to the point of causing anxiety and depression,” said Dr. Wosnitzer. “When patients see me, as part of our multidisciplinary protocol, I’ll offer references to address each medical issue related to male infertility. Mental health resources including acupuncture, massage, couple’s therapy, and mental health professionals are an integral component of our approach.”
Interested in learning more? Find a urologist near you.
YNHHS uses the terms "female" and "male" to reflect biological status typically assigned at birth, and "women" and "men" when referring to gender. According to the Human Rights Campaign, a doctor or midwife assigns a child's sex, male, female or intersex at birth based on their external anatomy. Gender identity is one's innermost identification of self as male, female, a blend of both or neither. Gender identification may differ from birth sex.
