Male InFertility

For a typical heterosexual couple, the likelihood of pregnancy ranges from 20% to 37% within 3 months, 75% within 6 months, and 90% within 1 year. If conception does not happen in the first year, around 50% of couples will achieve pregnancy in the following year. If attempts to conceive are unsuccessful for more than a year, or sooner if the woman is over 35, seeking advice from a fertility specialist is advisable. About 20% of infertility cases are attributed to male factors alone, while 30% involve both male and female factors.

Freqently Asked Questions About Male Infertility

How is Male Fertility Evaluated?

Male fertility evaluation begins with a physical exam and medical history, followed by a semen analysis. The semen, collected through masturbation in a sterile container, provides crucial information about sperm quantity, movement, and shape. If the results are normal, it is likely that the man is reproductively healthy. Abnormal results may prompt further evaluation. Hormone blood tests can also aid in assessing male fertility issues, recognizing that factors affecting sperm may have occurred within the previous 3 months.

How Often Should a Couple Have Intercourse?

To optimize the chances of pregnancy, couples should engage in intercourse 2 to 3 times a week during the fertile period. Having intercourse every 1 to 2 days during the fertile window increases the likelihood of conception, with the most favorable time frame being within the 6-day period ending on the day of ovulation.

Are there Practices that can Improve Our Chances of Getting Pregnant?

Sperm reach the fallopian tubes within minutes of ejaculation, regardless of intercourse position. Orgasm or prolonged rest after intercourse does not enhance the chances of pregnancy. However, the use of some lubricants, including commercial products and substances like saliva, olive oil, and KY Jelly^®, during the fertile period may hinder sperm movement. Consulting with a urologist about safe lubricant choices is recommended.

Adopting a healthy lifestyle can enhance male fertility. Maintaining an ideal weight, consuming a diet rich in antioxidants, taking multivitamins, managing stress, and controlling chronic medical conditions can positively impact sperm quality. Remember that lifestyle changes may take about 3 months to reflect improvements in sperm. Couples with underlying medical or genetic conditions should seek advice from a urologist to ensure the best approach to fertility.

Does Diet Affect Fertility?

Obesity is linked to impaired sperm production. Men seeking optimal fertility should strive for an ideal body weight. Antioxidants like vitamins E and C, which are present in most multivitamins, may slightly increase sperm count and movement. A balanced diet with fruits and vegetables provides natural antioxidants.

Do Smoking and Recreational Drug Use Impact Sperm Quality?

Smoking is associated with reduced sperm quality, and men trying to conceive should consider quitting immediately. Recreational drugs, including anabolic steroids and marijuana, are linked to impaired sperm function and production and should be avoided.

Are Boxers or Briefs Better?

While inconclusive, some studies suggest that briefs may raise scrotal temperature, potentially impacting sperm quality. Wearing boxers instead of briefs may reduce this effect. Regardless, avoiding situations that elevate scrotal temperature, such as hot tubs or laptops on the lap, may improve sperm quantity and quality.

What Else can Affect My Sperm Quality?

Certain medications, chronic medical conditions, and high fevers can impair sperm production. Consult your doctor to understand how your medications or conditions may affect fertility potential.

What is a Vasectomy Reversal?

A vasectomy reversal is a procedure for men who have previously undergone a vasectomy and now wish to have a child. This surgical intervention reconnects the vas deferens, creating a pathway for sperm to reenter the semen. Typically, the cut ends of the vas are reattached, and, in some cases, they may be joined to the epididymis. The success of the reversal is highest when performed sooner rather than later after the vasectomy. It is crucial to inquire early in the planning process whether a reversal procedure is covered by health insurance, as most health plans do not.​

How is a Vasectomy Reversed?

Vasectomy reversals are performed in an outpatient setting at a hospital or surgery center. Microsurgery (the preferred method) is typically conducted while the patient is under anesthesia. During the procedure, a high-powered microscope magnifies the small tubes, allowing the urologist to use ultra-thin stitches to reconnect the ends of the vas. Small incisions are made on each side of the scrotum to remove tissue from the vas, which was closed during the vasectomy. Vasal fluid is then extracted and examined under another microscope to determine the presence of sperm.​

Two Types of Reversal Procedures are Currently Performed:

Vasovasostomy reconnects the ends of the vas deferens, allowing sperm to flow naturally. When performed using microsurgery, vasovasostomy has a success rate of approximately 95%.

Vasoepididymostomy, a more complex procedure, is performed when a blockage affects another portion of the vas deferens or testicular tissue. This procedure bypasses the blockage by joining the upper end of the vas to the epididymis. Vasoepididymostomy has a success rate of approximately 70%.

Sperm freezing during the reversal is recommended in case the microsurgery is not as effective as planned.

After Treatment

The recovery process is typically swift and manageable. Post-operative  pain is usually controlled with oral medication and rarely lasts beyond a few days to a week.  Most men can resume normal activities and light work within a week, while strenuous activities and sexual activity are generally safe after 2 to 3 weeks.

Achieving pregnancy after vasectomy reversal may take 4 months to a year. Testing sperm count is the primary method to assess surgical success, with periodic semen analysis recommended until sperm count stabilizes or pregnancy occurs. Sperm may appear in semen within a few months after vasovasostomy, while vasoepididymostomy may take between 3 to 15 months.

What are Varicoceles?

Varicoceles occur when veins inside the scrotum (the sac that holds the testicles) become enlarged due to poor blood flow. These veins, known as the pampiniform plexus, may appear like a “bag of worms” as they expand. Varicoceles, which are similar to varicose veins in the legs, are most commonly found on the left side and affect 10 to 15 out of every 100 men. In most cases, varicoceles are benign and do not cause issues. However, they can cause pain, impact fertility, or hinder testicular growth in young boys.

Varicocele Diagnosis

Self-exams and routine medical examinations are common methods of detecting varicoceles. A scrotal ultrasound may be ordered by a urologist to visualize the scrotum’s interior.

Treatments for Varicocele

Varicoceles are often left untreated unless they cause pain, fertility issues, abnormal semen, or slow testicle growth in boys. If necessary, surgery is the primary treatment option. Microscopic or laparoscopic procedures involve tying or removing the affected veins to prevent blood pooling. Another option is embolization, in which a tiny coil and/or fluid is inserted into the blood vessel to redirect blood flow away from the varicocele. Recovery is usually quick, with mild pain, and additional fertility treatments may be considered.