Many Men Undergo Assisted Reproductive Techniques without a Full Workup
A new study presented at the annual American Urologic Association meeting by Dr. Jarvi and co-authors out of Toronto found that many couples with male factor infertility are being treated with intrauterine insemination (IUI) or in vitro fertilization (IVF) prior to the men having a full urologic history, exam, and workup. This is a disservice to our patients and their partners as many causes of male infertility could be reversible. In this study, 5% of men taking testosterone showed suppressed sperm production, which can be easily reversed by stopping testosterone treatments. Many of these patients were also taking Propecia (finasteride) which can affect fertility.
Infertility is defined as the inability to achieve pregnancy after 1 year of unprotected sex. It affects up to 15% of couples. Male infertility is present in up to 50% of couples (20% male alone, and 30% combined male and female). This underscores the importance of appropriate testing for both males and females.
Testing for Infertility
Male fertility is assessed with a medical and sexual history, physical exam, and 2 separate semen analyses after at least 2 days without an ejaculation. The shape, motility, and absolute number along with other parameters are assessed. If these are abnormal, then blood hormone levels may also be checked.
Causes of Infertility
One of the most common causes of infertility is a varicocele. This is an abnormal collection of veins in the scrotum and is reversible with an outpatient procedure. Another common cause is prior genital surgery, particularly a vasectomy. Vasectomy reversal is highly successful and typically less expensive than IVF. Other causes may include hormonal imbalances or genetic disorders but are less common. Often the cause of infertility will be classified as idiopathic, which means that there is no identifiable cause for the infertility.
Lifestyle modifications can have a significant improvement in male infertility. Drugs, tobacco, and alcohol can affect semen parameters so stopping these can lead to improved chances of fertility. Smoking cessation has been shown to improve semen analyses by as much as 15%! Marijuana and excessive alcohol use can affect the hormonal axis as well as the semen analysis.
As discussed, male infertility is a significant contributor to difficulty conceiving in over 50% of couples. The good news is our doctors can help. If you and your partner are experiencing fertility issues, schedule an appointment for an appropriate workup.