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Trying to Conceive: Male Fertility Guide

It takes two to make a baby: an egg and a sperm. If you and your female partner are having trouble conceiving, infertility may be a factor. One in 10 couples experience some form of infertility when trying to have a baby.

According to the American Society of Reproductive Medicine (ASRM), one-third of infertility is attributed to the female partner; one-third to the male partner; and one-third to a combination of problems in both partners.

It may seem like more couples are experiencing infertility, but that’s not necessarily so as compared to prior decades, says Dr. Harry Fisch, a board-certified urologic medical doctor and microsurgeon who specializes in infertility and reproduction. He is a clinical professor of urology and reproductive medicine at New York-Presbyterian Hospital/Weill Cornell Medical College.

“I think people didn’t talk about infertility years ago because the treatments weren’t there,” says Fisch, who has researched and written about the “male biological clock.”

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Many people blame environmental factors for lower sperm counts, but it’s really because couples are waiting longer to have a baby, he says. “As you age, sperm counts decline, your hormones decline, and older men’s sperm may have more genetic problems. In women, fertility starts to decline at age 30,” Fisch says. “My advice? Try to have a baby younger.”

A fertile male must be able to have an erection and ejaculate healthy sperm that can fertilize the female’s egg during ovulation. Couples under age 35 who have not conceived after a year of unprotected sex should consult a reproductive endocrinologist; over age 35, the visit should occur after six months.

You can’t ignore the major age factor. “If you are in the upper 30s, it’s almost impossible not to have problems conceiving,” says fertility specialist Dr. Shahin Ghadir, a founding partner of Southern California Reproductive Center, and assistant clinical professor at UCLA andUSC.

What Is “Healthy” Sperm?

According to medical experts at Johns Hopkins Medicine, male infertility is often caused by abnormalities with sperm, including:

Low or no sperm count Morphology - abnormally shaped sperm that may struggle to reach and penetrate an egg. Motility - the ability of sperm to “swim” through the female reproductive tract. Vitality – how many are alive

Home sperm test kits such as SpermCheck Fertility, available online and at pharmacies, can measure sperm concentration, but reproductive specialists warn that they don’t provide crucial details. If the home test reveals a concentration below 20 million sperm per milliliter, however, you may want to get evaluated by a urologist, who will be able to determine other possible abnormalities.

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What Should I Expect During a Medical Male Fertility Evaluation?

Most couples begin with a visit to a reproductive endocrinologist. The initial visit will likely include a review of the couple’s medical histories, and a semen analysis. The man will be requested to refrain from ejaculation for about 48 hours before the test, which requires masturbating into a cup.

“Semen analysis results vary widely from sample to sample and throughout the year,” Fisch says, noting that his patients are asked to provide two semen samples.

If abnormalities are found in the semen sample, the man will be referred to a reproductive specialist – typically a urologist – who will conduct a physical examination and may order more tests such as blood work, an ultrasound, and possibly a testicular biopsy.

In evaluating a man’s fertility, a urologist will review a man’s medical history, including recent high fevers, hernias, and childhood diseases. The doctor will look for signs of hormone deficiency such as decreased facial and body hair, and decreased muscle mass.

The doctor will want to know about any prior injuries to the testicles or penis, and ask about a man’s libido (sexual desire) or difficulty maintaining an erection (erectile dysfunction). Blood tests may be ordered to measure hormones in the blood, including testosterone and follicle-stimulating hormone, thyroid hormones and prolactin.

What Causes Sperm Abnormalities?

Many things can impact sperm, including:

Age – sperm counts decrease as a man gets older. Varicoceles, which are enlarged veins “that warm the nearby testicle unnaturally and cuts sperm production,” Fisch says. Childhood infections such as mumps, especially after puberty. Problems with the pituitary glands. Environmental factors such as exposure to radiation, toxins and possibly the Zika virus. Lifestyle factors such as weight. “People talk about environmental issues like pollution, but personal issues like weight are more critical,” Fisch said. “The bigger the belly, the lower the testosterone. And underweight men are the worst for lower sperm counts.” Use of tobacco, marijuana, steroids and excessive alcohol. Sexually transmitted diseases, and urinary tract infections – UTIs are not just in women. Some prescription medications. Blockage of the genital tract from a genetic defect, sexually transmitted disease or surgical scar tissue.

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What Should I Do Before We Try to Get Pregnant?

Before trying to start a family, it’s wise for men to become as healthy as possible.

Stop smoking or vaping, including tobacco and marijuana. “Cigarette smoking decreases blood flow. And vaping – I don’t know what chemicals are in them,” Fisch says. Avoid heavy alcohol use, and limit recreational drinking. Maintain a healthy weight. Eat a healthy diet. Do not take steroids. “Big muscle men have very small testicles,” Fisch says. Switch out of your “tighty whities” and wear boxer shorts or loose-fitting underwear, to keep the testicles cool. For the same reason, keep your laptop computer off your lap. Avoid hot tubs, saunas, “and no spinning or cycling,” Ghardir recommends. Avoid lubricants during sex, or use brands that won’t impact sperm, such as Pre-Seed or Conceive Plus.

What Can I Do to Improve My Sperm?

Just as women start taking prenatal vitamins before trying to become pregnant, some doctors recommend supplements for men that may improve sperm quality. “I like a brand called Naturally Smart for Men, but having a healthy diet is very important,” Ghadir says.

Clomid is often prescribed for women to improve fertility, but it’s also prescribed for men to boost testosterone levels, which, in turn, usually helps sperm production, Fisch adds.

How Can Modern Medicine Help Me Increase My Chances of Conceiving?

Even if you have a low sperm count, or your sperm are swimming at a dial-up speed rather than 5G, you can still be fertile. You might just need a medical assist to move the process along at a faster rate.

A reproductive endocrinologist may offer several options:

For low sperm counts, intrauterine inseminations (IUI) or in vitro fertilization (IVF) can increase the chances of sperm fertilizing a woman’s egg. A newer technique called intracytoplasmic sperm injection (ICSI) involves the direct injection of sperm into eggs obtained through IVF. “It definitely improves the odds,” Ghadir says. Varicocele repair is done through a single incision in the abdominal area, and may be performed with local, regional or general anesthesia, depending on the preference of surgeon and patient, Fisch says. Men who have had vasectomies can often have it surgically reversed. New microsurgical techniques have led to improved pregnancy rates following vasectomy reversal, even in the most extreme cases, Fisch says. In some cases, sperm can also be extracted directly from the testicles, Ghadir says.

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Dealing with Financial and Emotional Challenges of Infertility

Advances in medicine have made it possible for many couples to become pregnant, although not every insurance plan will cover all the associated costs.

Ghadir supports the Family Equality Council and has helped hundreds of LGBTQ couples and individuals build their families. He arranges special discounts for military families “because of what they do to protect us.” And Ghadir started his own charitable organization called Fertility For All to help raise awareness and funds for those who can’t afford the fertility journey.

Trying to conceive for many months with no success can lead to emotional stress on both partners. Resolve, the National Infertility Association, provides educational resources and support groups that are led by peers or professionals.

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