Unfortunately, we know that difficulty conceiving among couples isn’t uncommon, affecting as many as 1 in 6 couples. What we don’t often mention is that men can contribute to infertility, too. As many as 30% of infertility cases are at least in part attributable to male factors, and in fact, about 20% of all infertility cases are due to male factors alone.
So, why is this happening? The contribution required from men for conception to occur involves an adequate number of sperm that look and move normally, but over the last 40 years, the sperm count in developed countries (yep, that’s us) has declined by roughly 50%. From 1973 to 2011, sperm counts for men in North America, Australia, Europe and New Zealand declined by 59.3% and sperm concentration declined by 52.4% Fortunately for Asian, African and South American men, they seem relatively unaffected so far.
How does your partner know if he’s affected? A semen analysis can answer the question of whether he’s producing adequate sperm and whether or not they have a normal appearance and motility (they’ve got to be able to get where they’re going – it’s a long trip!). A normal sperm count is at least 15 million sperm per milliliter of semen, and a minimum of several milliliters produced during each ejaculation.
If his semen analysis isn’t normal, what are our options? Depending on how abnormal the analysis is, lifestyle changes may be the easiest first step. Known risk factors for a low sperm count are obesity, smoking and excessive drinking, exposure to certain chemicals or radiation, frequent hot tub/sauna use, steroid use, and too tight underwear (yes, seriously-this can increase temperature in the scrotum and damage sperm, no matter how good he looks in them!). If your partner meets any of these criteria, then lifestyle changes may be a simple place to start for improving sperm count and quality. Medical history aspects can also play a role, for instance an undescended testicle or varicocele (dilated blood vessel) or lump may require surgical management by a urologist prior to conceiving. Lastly, a testicular infections should be treated immediately, whether sexually transmitted such as gonorrhea, or simply increase white blood cells noted in the semen analysis. Vaccination against mumps (MMR) can prevent orchitis, another infection that can affect the testes and may result in male infertility by affecting sperm production or transport.
We’ve tried all of the things listed above, and still no luck. What now? For those whose sperm counts are only mildly low, IUI (intrauterine insemination) may be a reasonable option. Essentially, your ob/gyn takes the sample produced by your partner and places it directly inside the uterus closer to the egg rather than having the sperm make the trek from the vagina. Kind of a head start on the race for fertilization. If there’s either severely diminished counts or absence of sperm altogether, meeting a reproductive endocrinologist to discuss IVF may be your best bet. Sometimes this can involve sperm directly extracted from your partner’s testes (yep, just like it sounds), or sometimes donor sperm may be required.
Infertility struggles can often be a sensitive issue and may even be tough to discuss with your partner. In many cases, though, involving him not only in the discussion of infertility but also having him participate in the evaluation can help shed some light on why conceiving is hard in nearly 1 in 3 cases. Involving him now in these difficult conversations will be good practice for involving him in difficult conversations later (for instance, when it comes time to divide up those late night diaper-changing duties 😉 )
Dr. Nick
So, why is this happening? The contribution required from men for conception to occur involves an adequate number of sperm that look and move normally, but over the last 40 years, the sperm count in developed countries (yep, that’s us) has declined by roughly 50%. From 1973 to 2011, sperm counts for men in North America, Australia, Europe and New Zealand declined by 59.3% and sperm concentration declined by 52.4% Fortunately for Asian, African and South American men, they seem relatively unaffected so far.
How does your partner know if he’s affected? A semen analysis can answer the question of whether he’s producing adequate sperm and whether or not they have a normal appearance and motility (they’ve got to be able to get where they’re going – it’s a long trip!). A normal sperm count is at least 15 million sperm per milliliter of semen, and a minimum of several milliliters produced during each ejaculation.
If his semen analysis isn’t normal, what are our options? Depending on how abnormal the analysis is, lifestyle changes may be the easiest first step. Known risk factors for a low sperm count are obesity, smoking and excessive drinking, exposure to certain chemicals or radiation, frequent hot tub/sauna use, steroid use, and too tight underwear (yes, seriously-this can increase temperature in the scrotum and damage sperm, no matter how good he looks in them!). If your partner meets any of these criteria, then lifestyle changes may be a simple place to start for improving sperm count and quality. Medical history aspects can also play a role, for instance an undescended testicle or varicocele (dilated blood vessel) or lump may require surgical management by a urologist prior to conceiving. Lastly, a testicular infections should be treated immediately, whether sexually transmitted such as gonorrhea, or simply increase white blood cells noted in the semen analysis. Vaccination against mumps (MMR) can prevent orchitis, another infection that can affect the testes and may result in male infertility by affecting sperm production or transport.
We’ve tried all of the things listed above, and still no luck. What now? For those whose sperm counts are only mildly low, IUI (intrauterine insemination) may be a reasonable option. Essentially, your ob/gyn takes the sample produced by your partner and places it directly inside the uterus closer to the egg rather than having the sperm make the trek from the vagina. Kind of a head start on the race for fertilization. If there’s either severely diminished counts or absence of sperm altogether, meeting a reproductive endocrinologist to discuss IVF may be your best bet. Sometimes this can involve sperm directly extracted from your partner’s testes (yep, just like it sounds), or sometimes donor sperm may be required.
Infertility struggles can often be a sensitive issue and may even be tough to discuss with your partner. In many cases, though, involving him not only in the discussion of infertility but also having him participate in the evaluation can help shed some light on why conceiving is hard in nearly 1 in 3 cases. Involving him now in these difficult conversations will be good practice for involving him in difficult conversations later (for instance, when it comes time to divide up those late night diaper-changing duties 😉 )
Dr. Nick
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