Male-factor infertility is usually first detected through a semen analysis. This test measures the total number of sperm in a sample and evaluates their movement and shape. If the test shows that a man has fewer than 39 million sperm per sample, less than 40% moving sperm, or less than 4% normally shaped sperm, then fertility treatments should be the next step.
Men with an abnormal semen analysis should have their hormones evaluated through a serum hormonal profile and be examined by a urologist specializing in male fertility to determine any additional factors inhibiting conception. In men with sperm counts less than five million, genetic testing (karyotype & Y chromosome deletion) may be necessary.
During the diagnostic phase, a physical exam will be performed by a urologist in addition to the semen analysis. The exam will check for normal genital structure, including presence, size, and consistency of the testes.
The goal of these initial tests is to identify male infertility causes that can be corrected to enhance fertility, but they may also uncover serious health concerns such as testicular tumors, and genetic and hormone disorders.
Erectile Dysfunction and male infertility
Outward signs of male infertility may be inconspicuous, but one obvious indicator can be erectile dysfunction. Erectile dysfunction (ED) is the consistent inability to attain and maintain an erection to permit satisfactory intercourse, and it affects 18%-89% of men with male-factor infertility. Sufficient erections are vital to natural conception, and they are often necessary in order to provide sperm for intrauterine insemination (IUI) or in vitro fertilization (IVF).
Two types of ED may be affecting your fertility: psychogenic and organic. Psychogenic ED is when a man has normal penile blood flow and can achieve an erection in some instances, but not while trying to conceive with his partner. It is believed that most cases of ED that occur after a couple begins trying to conceive are psychogenic. Organic ED, on the other hand, is when a man does not have normal penile blood flow or nerve function, and his inability to attain and maintain an erection is not situational.
If your partner suffers from ED, it is important to realize that this condition is not indicative of his attraction to you or status of your relationship. In most cases, both psychogenic and organic ED can be treated, ultimately resolving the problem. Medications, injections, or surgery may be prescribed as treatment. In the case of psychogenic ED, 32% of men no longer experience symptoms immediately after diagnosis.
Ejaculatory Dysfunction and male infertility
Ejaculatory dysfunction, or the absence of an ejaculation after an orgasm, is a male infertility cause that can have a substantial impact on a couple’s ability to conceive. Men may experience a “dry orgasm” due to a complete lack of seminal emission, retrograde ejaculation where the ejaculate flows backward into the bladder, or an ejaculatory duct obstruction. While treatments are available for ejaculatory dysfunction, sperm harvesting for use in IUI or IVF is also an option.
Men receiving treatment for ED or ejaculatory dysfunction may want to consider sperm banking in order to ensure the availability of sperm at key times during female infertility treatments.
In addition to physical exams and tests, it will be important for us to get a clear picture of your medical history.