Semen analysis and sperm counts aren't the most enticing topics of conversation for most men, but if you're having trouble conceiving, you may need to have "the talk" with your guy.
When couples experience infertility, there's often a misconception that the problem is the woman's. But according to the American Society for Reproductive Medicine, infertility issues are split evenly between males and females. Each group is responsible for 30 percent of infertility, and the rest is attributable to a combination of both male and female factors or unexplained reasons. Therefore, it's important to have both partners' fertility checked if you're having trouble getting pregnant. See a specialist if you're under 35 and have tried to conceive for a year, or if you're over 35 and have tried for six months.
If a male factor is what's making it tough for you and your partner to conceive, it's important to understand what may be causing his infertility and what your options are. Here are answers to 10 common questions.
1. How can I convince my guy to go to the doctor?
Some men don't even like to visit the doctor for a regular checkup, so the thought of going for a fertility workup is probably not at the top of your guy's to-do list. Even though he may not show it, your guy may be feeling like he's less of a man if he can't get you pregnant right away.
But not being proactive about your fertility may be even less manly, according to Denny Ceizyk, the author of Almost A Father: A Memoir of Male Infertility; A Love Story About My Soulmate, Our Soulbaby, and The Music in Between, who was diagnosed with low sperm count. "Not 'checking your boys' after one year of 'trying to have a baby on your own is like ignoring the 'check engine' light when it first goes on. It could be nothing, but if you let it go, it could cost you far more in the long run that if you just take care of it soon after that warning signal first appears," he explains.
If your guy feels uncomfortable or embarrassed about that first doctor's visit, offer him your support and remind him you're in this together. Whether infertility is identified as male or female factor, it is a shared problem in a relationship and should be addressed as a couple.
2. What is male infertility?
"Male infertility is a condition in which the male reproductive tract and sperm has diminished capacity to lead to the eventual fertilization of the egg to produce an embryo," explains Melissa Esposito, M.D., a board-certified reproductive endocrinologist at Shady Grove Fertility Center in the Washington, D.C., area. Sometimes male infertility can be the sole problem for a couple trying to get pregnant, but infertility can also be caused by a combination of female and male factors.
3. What causes male infertility?
The following are common causes of male factor infertility:
Structural abnormalities that partially or totally block the flow of sperm and/or seminal fluid. Men may be born with abnormalities or the abnormalities may result from infection or surgery.
Sperm production disorders, when the production of sperm is inhibited. This may happen in men who have had a vasectomy or who have a varicocele that may cause low sperm count and decreased sperm quality.
Ejaculatory disturbances, such as impotence or retrograde ejaculation that prevent sperm from reaching the woman.
Immunologic disorders, like endocrine disorders or antisperm antibodies that prevent sperm from meeting and successfully penetrating the egg in the woman's genital tract.
Non-obstructive azoospermia, which means the testicle is not producing any sperm or is producing sperm in such low quantities that it cannot be detected in a standard semen analysis.
Obstructive azoospermia, in which sperm is produced, but cannot be discharged doesn't come out because of an obstruction.
4. Are there any underlying health issues that cause male infertility?
Like women, men can have abnormal thyroid or prolactin hormone levels, which can lead to impaired reproductive function. Luckily, these problems can be treated medically and fertility is often restored.
Toxins from chemotherapy or radiation therapy are another culprit of infertility; they can severely damage testicles. Dr. Esposito says that men often recover from this type of damage, but it may take a few years, and in some cases the damage is too severe. This is why doctors recommend that young men diagnosed with cancer bank sperm before undergoing chemo/radiation therapy.
To determine if an underlying health issue is the problem with your guy, his doctor will do a thorough medical history and can discuss additional issues that may be behind his infertility.
5. How is male infertility diagnosed?
Male infertility is usually diagnosed through a semen analysis, and for the most part, abnormalities are associated with the sperm. The sample will be tested for volume of ejaculation, sperm concentration, sperm motility (how well sperm move), and sperm morphology (the size and shape of the sperm).
"There are many other tests out there but none that have been shown to correlate with male fertility as well as the standard semen analysis does," Dr. Esposito explains.
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6. What emotions might my guy experience as he goes through infertility treatments?
He may be riding an emotional roller coaster, but depending on his communication style, he may not show it. Encourage your partner to open up to you or a professional counselor experienced in working with couples dealing with infertility.
"The diagnosis of male factor infertility often comes as a shock, as the inability to become pregnant is traditionally assumed to be a woman's problem," says Sharon Covington, M.S.W., L.C.SW.-C. "It's often experienced as an assault on a man's self-esteem and self-image, as much of society communicates that fertility and virility are linked. Thus, if a man cannot impregnate his wife, is he really a man?"
The answer to that question is another myth busted by Celzyk and RESOLVE, the national infertility association. "Dealing with infertility requires that guys evolve beyond the 'strong silent type,'" Celzyk says. "This is really a myth of perspective. You just haven't gotten your wife pregnant yet, in the way that you hoped it would happen. But the most virile man with a multimillion sperm count won't necessarily have a better chance of conceiving if there are complex fertility hurdles to overcome."
7. How will his infertility affect our relationship?
Infertility can affect even the strongest relationships. "Whether infertility is identified as male or female factor, it's a shared problem in a relationship," Covington explains.
Men often feel terribly guilty when they see how their wife is suffering because she's repeatedly not pregnant. In addition, a woman may be angry as well as guilty because she knows it's not her partner's fault. These feelings can cause each partner to withdraw from the other, both not wanting to hurt the other one by talking about their true feelings on the subject.
"Try to be sensitive and don't assign blame," Dr. Esposito advises. "Infertility is a very challenging and stressful life event. Couples need to be supportive of each other and find a doctor and a center that they feel provides needed support in an environment that is medically safe and reassuring."
8. Can male infertility be avoided?
According to Dr. Esposito, some of the myths you may have heard about tight underwear and hot tubs affecting a man' "swimmers" may be true. Many lifestyle choices can adversely affect male fertility.
"Anything that increases heat production in the scrotal and testicular area is not good," Dr. Esposito says. Most obviously, hot tubs and saunas are big no-no's. But the "too hot" list also includes wearing tight underwear, so when you're trying to get pregnant, boxers are better than briefs. Bike riding can also be a problem not only because of tight riding shorts, but also because the act of bike riding causes the male genitals to be in much closer proximity to the body, thereby increasing body temperature, which can decrease semen parameters.
Dr. Esposito also cautions against smoking tobacco or marijuana as well as excessive alcohol use or other recreational drug use when trying to conceive. "All of these can adversely affect sperm concentrations, how well the sperm are moving, and how many sperm are normally formed," she explains.
9. How is male infertility treated?
Different treatments are available depending on what is causing the problem, such as extracting sperm from the testicle to be injected into an egg for in vitro fertilization or washing sperm to be used during alternative insemination. Dr. Esposito says that hormone-stimulating drugs commonly used to treat female infertility may actually help guys too. These work similarly in men; some, such as Clomid, help the brain to secrete more hormones that will increase sperm production, and others cause the testicles to increase sperm production. Your guy's fertility doctor or urologist will discuss the best course of treatment for his particular issue.
10. What if fertility treatments don't work?
The journey to parenthood is different for everyone. If you and your partner are unable to conceive by what Celzyk refers to as "GOFI" (good old fashioned intercourse), there are many other ways to create your family. Options include egg or sperm donation, surrogacy, in vitro fertilization, and adoption. Be sure to discuss these possibilities and any next steps with your fertility specialist.