When a couple can’t have a baby, nine times out of 10, the woman is going to blame herself for the problem.
But the reality? About 40 percent of infertility is related to the woman, 40 percent is related to the man, and the remaining 20 percent is a combination of both.
Male fertility—and infertility—typically comes down to the amount of sperm available and their motility, or how fast they move, said Dr. Lawrence Layman, a reproductive endocrinologist with Augusta University Health. “Still, many times when we look at a semen analysis, in infertile males, there’s not that much difference when compared with fertile males. So you can’t totally discern fertility just from a semen analysis.”
Other factors that can affect sperm include the amount of follicle stimulating hormone (FSH) in the bloodstream, which helps ensure healthy sperm. The amount of luteinizing hormone (LH) is important too since it stimulates testosterone production, which is needed for a good sperm count.
Having an underactive thyroid can also affect the quality and number of sperm, and can even cause erectile dysfunction or a low libido.
Wondering what’s normal? Typical ranges of sperm are 15 to 20 million per cc, with a volume of 1 to 5 ccs, and 40 to 50 percent motility. For FSH and LH, normal is usually 2 to 10 mIU/mL, and for thyroid, .5 to 4 uIU/L for thyroid stimulating hormone (TSH).
Infertile? All I need is more testosterone, right?
Here’s the thing about testosterone that most people don’t know: Even though it’s important for sperm production, testosterone supplements actually act like a contraceptive, causing infertility.
“When you give testosterone to a man, it inhibits reproduction,” said Layman. “It’s the same as in a woman if you were to give estrogen and progesterone. Both of these are important in pregnancy, but they also are the ingredients in birth control.”
However, men can receive treatments to naturally stimulate their own testosterone production. These treatments depend on the outcome of semen analysis and levels of FSH, LH and TSH.
- If a man has one abnormal semen analysis: “Repeat it,” said Layman. “There can be a huge variation in sperm.” If a second analysis comes back normal, then there may not be an obvious issue—but it doesn’t necessarily mean there isn’t a more subtle problem.
- If a man has two abnormal semen analyses: Additional tests, including those mentioned above, are needed.
- If a man has low testosterone levels, along with low FSH and LH: Men can be treated with injections of FSH and LH to help boost testosterone levels, but these are very expensive. Injections of hCG or human chorionic gonadotropin, another hormone, is usually used to help boost testosterone production when testosterone is low and FSH and LH are low. Another option is Clomid; although it’s usually considered a fertility treatment for women, in men whose sperm count is just a little low, Clomid may be enough to boost it to high enough levels.
- If a man has low testosterone levels, but high FSH and LH: “Unfortunately, this often is not very treatable,” said Layman. “We compare this to early menopause in women.” Still, while couples may not be able to become pregnant naturally or through intrauterine insemination, which requires 10 million motile sperm, a couple might still be able to pursue in vitro fertilization, since only about 20 to 30 sperm are needed for the procedure.
- If a man has a thyroid problem: Thyroid hormone replacement, usually in the form of a daily pill, is needed.
It’s also worthwhile to mention that if men have a very low sperm count or no sperm, your reproductive endocrinologist may have a serious discussion with you about chromosome abnormalities.
Certain chromosome problems, such as Klinefelter syndrome, can cause small testes that aren’t able to produce much sperm. The good news is that these kinds of syndromes aren’t inherited; however, a sperm donor may be necessary. IVF might be possible, but it does increase the risk of chromosome problems in children.
If no sperm are present, a biopsy of the testis by a urologist can give a possibility of getting sperm for IVF if chromosomes are normal and there are no deletions of the Y chromosome.
However, cystic fibrosis can cause low sperm, and the disorder can be transmitted to the child if the woman is a carrier. Genetic testing is a good idea since CF can lead to major lung problems and even early death.
So when can we try?
It can take up to three months to get sperm counts up once treatment begins. It still could take another three to nine months before pregnancy is achieved, depending on the circumstances.
Still, the good news in men is that if their infertility is treatable, treatments are very successful. “Men have many good options when it comes to infertility,” said Layman.