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Male Infertility: Causes, Diagnosis and Treatments

About one third of infertility cases are a result of male factors. However, approximately 50 percent of infertile men have a correctable form of infertility. 

According to the National Institute of Child Health and Human Development, 15 percent of couples worldwide are affected by infertility.  

The male partner is the sole cause of infertility in about 30 percent of couples. In another 20 percent of cases, the problem is related to reproductive issues with both the male and the female. 

“This means that 50 percent of infertility cases are in part caused by men,” says Martin Kathrins, MD, a urologist and reproductive specialist within the Division of Urology at Brigham and Women’s Hospital (BWH).

However, due to advanced treatments and surgical options, many causes of male infertility can be successfully treated.  

What causes male infertility?

Many factors can contribute to male infertility, including:

  • Low sperm production, abnormal shape, or poor motility
  • Anatomical abnormalities involving the testicles
  • Blockage in ducts that carry sperm  
  • Hormonal problems, such as low testosterone
  • Testicular trauma
  • Genetic or immunological conditions       

How is male infertility diagnosed?

“Infertile men don’t typically have symptoms. The most reliable way to diagnose male infertility is if they haven’t been able to conceive for a year,” says Dr. Kathrins. 

During an initial visit, a patient will undergo an evaluation to determine the exact causes of infertility. This evaluation may involve: 

  • Physical exam
  • Laboratory tests
  • Semen analysis  
  • Transrectal ultrasound (imaging of the prostate gland)
  • Testicular biopsy  
  • Hormonal profile (assess levels of pituitary hormones that stimulate sperm production)  

How is male infertility treated?

Since infertility can be a significant source of stress, Dr. Kathrins reassures men by explaining that most causes of infertility are inherited, or the result of some bodily dysfunction. In other words, if a man is having trouble conceiving, it’s not their fault.  

“I also remind patients that most patients have a correctable form of infertility. If the man falls into this 50 percent category, we can treat the issue with medicines or surgery,” says Dr. Kathrins.  

The most common surgically-correctable cause of male infertility is a varicocele, a swollen vein in the scrotum. About 40 percent of infertile men have a varicocele. In most cases, a varicocele isn’t serious.

“Some physicians may recommend waiting and watching a varicocele. If needed, a short outpatient surgical procedure can close off enlarged veins,” says Dr. Kathrins.

If infertility is the result of a deficiency in testosterone, low or declining hormone levels can be corrected with hormonal therapies.

Ensuring the best chances of conceiving

For infertility cases caused by factors that can’t be treated through surgery or hormone therapy, couples can explore infertility treatments such as in vitro fertilization (IVF).

“At Brigham and Women’s Hospital, we care for men and women in separate offices, but all of our fertility specialists work closely to give couples the best possible chances of conceiving,” says Dr. Kathrins.    

- Dustin G. 

In this video, reproductive specialist Martin Kathrins, MD, Division of Urology at Brigham and Women’s Hospital, explains the causes and potential treatment options for male infertility.