Male Infertility: What to Know and How to Cope

Facts:

• As with female infertility, male infertility isn’t anyone’s “fault.”
• In the past three decades, according to a large study published in 2017, sperm counts have decreased 50% over 40 years in industrialized nations such as the United States, Australia, New Zealand and those in Europe.
• The most common cause of male infertility is low sperm count, but in more than 20% of cases, there’s no known cause.
• As with women, men have a biological clock; and research suggests that starting in their 40s, men may take longer to conceive with their partners than men who are younger do.
• If you’re a man who is infertile and is experiencing shame, depression or loneliness, seeing therapists or joining support groups can help.
• If you’re not able to conceive naturally or through assisted reproductive technologies, such as I.V.F., consider other options such as sperm donation or adoption.

Understand the most common causes of male infertility

You may have read news reports that sperm counts are dropping. It’s true that a 2017 analysis of 185 studies — which looked at semen samples from nearly 43,000 men from 50 countries — concluded that sperm concentrations per million milliliters of semen had declined by about 52 percent in men from North America, Europe, Australia and New Zealand between 1973 and 2011.

Still, as many as 80% of men who are infertile have low sperm counts. One frequent reason for this is a varicocele, or an enlarged vein in the testicle, which can affect the amount or shape of sperm. Most of the time, varicoceles (which are common) don’t lead to fertility issues, but they’re estimated to occur in 35% of men tested for infertility. If the varicoceles are particularly large — as they are in 3% of men

Most men with a varicocele don’t show symptoms and are unaware that they have one, though most doctors find them during a physical exam of the testicles. An ultrasound can confirm the diagnosis. If your doctor believes a varicocele is the reason for your infertility, a procedure that cuts and ties the enlarged vein can boost your chance of pregnancy success.

Other issues — such as a condition called retrograde ejaculation, where semen enters the bladder during orgasm instead of coming out of the tip of the penis — can contribute to low sperm count. With epididymitis, there’s an actual blockage in the ducts that transport sperm from the testicles, so they can’t leave the urethra during ejaculation. These conditions can sometimes be treated with surgery.

Consider how your age can affect your risk

According to recent data, about 9% of births were fathered by men of “advanced paternal age,” meaning — depending on which definition you use — that they’re above 35 or 45. According to one 2003 study cited in a 2019 review, fathers older than 45 were nearly five times more likely to take more than a year to get their partners pregnant than men who were 45 or younger, even when their partners were under 25.

Realize that diet and lifestyle may play a role

Women are often advised to get themselves “pregnancy ready” far before they even begin trying to conceive, such as by maintaining a healthy weight, taking a folic acid supplement each day and avoiding cigarettes and alcohol. Similar strategies may hold true for men.

One reason sperm counts may be dropping globally, is because of the rising rates of obesity. Smoking and heavy drinking may also be factors. Diet may be important, too. There’s also evidence to suggest that heat — particularly from tight undergarments — may play a role.

If you’re struggling to conceive, get evaluated

WHO has advised that all couples who can’t get pregnant after a year of unprotected intercourse — or after six months of trying if one or both members of the couple are over 35 — seek medical help. It’s important for both partners to be checked by a fertility specialist at the same time. The next step is to do a semen analysis, or sperm count, which provides information about the number, shape and speed of your sperm. If the results of your semen analysis suggest that your sperm counts are low, don’t panic: Sperm counts can fluctuate week to week, and even sometimes from day to day. Your doctor will most likely order a repeat of the semen analysis about a month later.

Seek support

At wawa fertility you can meet men in similar situations and read about their story. It helps men deal with a variety of situations, such as feeling sensitive on Father’s Day or receiving unsolicited advice.