A Urologist’s Guide to Male Fertility

  • Problems with sperm production (the biggest list, including varicoceles, genetics, hormonal problems)
  • Problems with sperm delivery (ejaculatory duct obstruction)
  • Problems with sexual function (erectile and ejaculatory dysfunction)
  • Lifestyle and environmental factors (smoking, obesity, drugs, medications)

Taking a step back: Sperm 101

  • First off is semen volume: the amount of fluid expelled in the ejaculate. Sperm is about five percent of the volume in ejaculatory fluid (most if it is fluids from the prostate and seminal vesicles).
  • Next is sperm concentration: the number of individual sperm per milliliter of semen.
  • Then, you’ve got sperm motility: your swimmers’ ability to move efficiently through the female reproductive tract. A semen analysis will look at the percentage of motile sperm, which should be 40 percent or higher. Progressive motility, the rate of forward movement, is also measured.
  • Finally there’s morphology, the shape and size of the sperm. A normally shaped sperm is a mere three micrometer-wide oval with a distinctive tail. Misshapen sperm can be a cause of infertility.

Diagnosis of male infertility

Causes of male infertility

Lifestyle factors that affect sperm

  1. Environmental factors: Some research suggests an association between poor semen quality (here we’re talking about sperm concentration, morphology, and motility) and airborne pollutants. Some pesticides like DBCP (a soil fumigant banned a while ago in the US but still found in some groundwater) can also have negative effects on fertility. Of course, it’s impossible to totally avoid all environmental contaminants, but they are something to keep on your radar while you’re trying for a baby.
  2. Alcohol: Binge drinking is not good for your fertility or other aspects of your health. Drinking excessively can lower testosterone levels, cause erectile dysfunction, and decrease sperm production. There’s also evidence that alcohol abuse and acute intoxication are associated with sexual dysfunction. Since The American College of Obstetricians and Gynecologists (ACOG) recommends women stop drinking altogether when trying to conceive, now would be a good time to switch to mocktails in solidarity.
  3. Diet: There’s a lot of conflicting advice online about diets that increase sperm count and volume. A look at nearly 8,500 men across various studies concluded that diets including fruits, vegetables, fish, and low‐fat dairy products as the main source of proteins are associated with better semen quality. So the basic guidance is this: try to maintain a healthy diet and avoid too many of the highly processed foods that are so good, but so bad for you. And if you want to cover your bases, though, try adding foods like asparagus, spinach, garbanzo beans, and lentils to your diet. They’re all rich in folate, which increases sperm growth (spermatogenesis). This nifty little vitamin is important for DNA maintenance, RNA transfer, and protein synthesis, too.
  4. Smoking: In addition to its numerous other harmful effects on your body, cigarette smoking has proven adverse effects on sperm health and overall fertility in both men and women, so stopping is in good interest.

Medical interventions

  • For example, a varicocele (dilation of veins in the scrotum) can be surgically corrected. This is a common procedure done to restore proper blood flow and health to the testes.
  • Or if a man needs to “undo” his vasectomy, a vasectomy reversal procedure can be done using a special microscope (“microsurgery”). The tubes are reconnected so sperm can again flow to the urethra. This is a highly technical procedure which should be performed by a urologist who specializes in microsurgery and male infertility. The surgery is an outpatient procedure done under anesthesia.
  • If fertility issues arise because of problems with erections or ejaculation, treatments for sexual dysfunction are available including medication and/or counseling.
  • Sometimes, medications to optimize hormone levels may be necessary to achieve maximal fertility.
  • Infections or inflammation of the genitourinary tract may require anti-inflammatories or antibiotics to treat.
  • Sometimes, advanced blood or semen testing may be necessary to get to the root of the problem.

What if none of that works?

  • PESA (Percutaneous Epididymal Sperm Aspiration): If sperm are not found in the ejaculate, they may be able to be retrieved directly from the epididymis (a structure that sits on top of the testes where sperm grow and mature before being ready to swim!). The simplest form of this involves collecting sperm from the epididymis using a small needle and syringe.
  • mTESE (microscopic Testicular Sperm Extraction) is a specialized procedure done with a microscope under anesthesia where a surgeon directly goes into the testis through an incision in the scrotum to extract sperm. This may be necessary if the number of sperm in the ejaculated semen is very, very low or zero.
  • IUI (intrauterine insemination) is a procedure where sperm are directly placed in a woman’s uterus around the time of ovulation. These sperm are concentrated and washed thoroughly beforehand. Sperm with higher motility and normal morphology can be specially selected for the procedure. This means that you can still be biologically related to your child, they just won’t be conceived through sex, but this is a route that countless people (heterosexual, lesbian, and transgender couples and single parents by choice) have relied on to grow their families. The total cost of IUI varies depending on insurance coverage and doctor’s fees. Usually it is around $500 — $4,000. Some people may choose to have the procedure done by midwives at home.
  • IVF (in vitro fertilization) involves a procedure where eggs are extracted from a woman’s body and combined with a sperm sample in a laboratory dish. This process fertilizes the egg, creating an embryo that is placed right back into the woman’s uterus where, if all goes well, it will implant and grow. Cost is again something to take into consideration for this procedure. One IVF cycle can cost anywhere from $15,000 to $20,000.
  • ICSI (intracytoplasmic sperm injection) is yet another treatment option that is part of IVF. Here, a specialized needle isolates and retrieves a single sperm cell from a sample — this helps ensure that the most viable sperm is selected, leaving nothing up to chance. Then, the needle is inserted into the egg’s cytoplasm (the gelatinous outer layer of the cell), and again, the resulting embryo is placed securely in the woman’s uterus.

Stay positive ✨




Fertility and pregnancy products. Inspired by beauty and backed by science. By moms, for you. ✨ www.natalist.com

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Fertility and pregnancy products. Inspired by beauty and backed by science. By moms, for you. ✨ www.natalist.com

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