While the infertility conversation often revolves around the female partner, the male partner’s role is just as important. Nearly half of all infertility cases are due—in part or in whole—to male factor infertility. Dr. Monica Best, who sees patients in SGF’s Atlanta-Northside and Buckhead-Piedmont locations, was recently an invited guest on an Atlanta radio show to discuss the causes of male factor and treatment options available to patients.
“The way I think about this simplistically is the 30:30:40 rule. 30 percent of the time, we often find a female factor, like blocked tubes, diminished ovarian reserve, fibroids, or PCOS where the woman isn’t making a mature egg each month,” Dr. Best explains. “30 percent is male whether or not it’s a sperm production issue or anatomic problem where sperm isn’t able to come out into the ejaculate properly. And in 40 percent of couples it’s both of them, so there’s some male and female factor that is combining and making it difficult for them to get pregnant.”
When asked about testing and seeking fertility care, Dr. Best notes, “It’s important to realize that couples are typically scared to come seek help because they’re afraid it’s going to be their fault or their partner’s fault. The reason for a comprehensive evaluation is so we don’t miss something on the female side, on the male side, or both.”
Male testing is simple and requires a semen analysis. Once the patient has provided a sample, there are several factors that are examined:
- Volume – Besides sperm, semen contains amino acids, enzymes, and several other secretions made by the male reproductive system. If the volume of ejaculate is low, that can mean the sample may be lacking in these important secretions that aid in the fertilization process. It could also signal a blockage or other issue in the semen’s pathway.
- Concentration – This is what people commonly refer to as the “sperm count.” A low concentration can signal a problem with the testicles or male hormones that is preventing the testicles from making enough sperm.
- Motility – The movement of the sperm is another important factor. If it is low, it can affect the ability of the sperm to reach the female reproductive tract and find the egg.
- Morphology – This item refers to the shape of the sperm in the sample. The head of the sperm is the part that penetrates and fertilizes the egg. If these are misshapen, it may mean they do not contain the proper enzymes or other materials that are necessary to complete fertilization.
Does a man’s age contribute to male factor infertility?
Dr. Best examines the difference between male and female fertility as it relates to age. “For men, they make new sperm every 3 months so technically, they have a rejuvenation of sperm. Whereas a woman’s eggs have been there even before she was born, and her egg supply continues to decrease over time. Also as a woman ages, over time, there’s some genetic injury to that pool of eggs, which increases risk of miscarriage.”
What causes male factor infertility?
“For some men, just like in women, there can be some unexplained issue where either the concentration of sperm or the motility of sperm is low. There can also be genetic reasons why men may not be creating enough sperm. The sperm counts are really low generally if there’s less than 1 million total motile sperm. We’re looking at their karyotype to see if their chromosomes are normal. Sometimes there can be a mutation on the Y chromosome, which is what makes someone male, and so that can be a reason for decreased sperm production,” states Dr. Best.
“The other thing is some people are born without what’s called a vas deferens, which is basically the tube that carries ejaculate from the testicle out through the penis and into the ejaculate. If there’s not a transport mechanism, they’re making sperm, but it can’t get out. Oftentimes that’s associated with a cystic fibrosis mutation, which can be more common in Caucasians, but we’ve also seen it in African-Americans, so that would be something that we would test. Also, some male children are born with undescended testes and if that’s not corrected right away after birth and it’s not identified until later, sometimes those men—because of the increased warming of the testicle inside of the body if it’s non descended—can cause low sperm counts later on.”
A man can overcome male factor infertility with a variety of treatment options. A diagnosis of male factor infertility is categorized as mild, moderate, or severe. The goal with any treatment is to get the sperm as close to the egg as possible. The severity of the case, the fertility status of the female partner, and comfort level of the couple together dictate the planned course of treatment. Luckily, this form of infertility is easily overcome with the right diagnosis, lifestyle choices, and treatment.
For more information about overcoming male factor infertility or to schedule an appointment with Dr. Best or another SGF physician, please contact our New Patient Call Center at 1-877-971-7755 or complete this brief online form.