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Key points
Key points- When a couple is unable to have children, the cause of infertility should be investigated in both partners.
- There are several causes of infertility in men, and some of them can be reversed.
- Many patients have no symptoms and only learn of infertility when they want to have children.
- Diagnosis combines a medical history, a physical exam, and tests such as semen analysis.
- Treatment is directed at the cause and is decided with your specialist.
Why male fertility should be evaluated
When a couple is trying to have children and cannot, the cause of infertility should be investigated in both partners. There are several reasons men may be unable to have children, and some of them can be reversed.
Before offering a treatment or any of the assisted reproduction options, the most common causes of infertility should be ruled out and, when possible, corrected.
Causes and risk factors of male infertility
Many anatomical or functional alterations of the male reproductive system can cause infertility in men. The most common are:
Anatomical alterations
Varicocele and cryptorchidism.
Inflammatory conditions
Epididymitis, prostatitis, and orchitis.
Functional, hormonal, and genetic alterations
Retrograde ejaculation, hormonal disorders, and genetic abnormalities.
Medical history
Radiation to the testicles, testicular cancer, and history of vasectomy.
Symptoms of male infertility
Some of the symptoms that may appear are caused by the testicular disease responsible for the infertility.
Pain and inflammation
Testicular pain and testicular inflammation.
Changes in the scrotum
Varicose veins in the scrotum and absence of one or both testicles.
Burning
Burning when urinating or ejaculating.
Diagnosis of male infertility
To make or confirm a diagnosis of infertility, the following may be important:
Medical history and exam
A complete medical history, a complete physical exam, and a genital examination.
Imaging
Testicular ultrasound, prostate ultrasound, and brain magnetic resonance imaging (MRI).
Laboratory tests
Blood hormone levels, semen analysis (sperm count), and semen culture.
Karyotype and biopsy
Karyotype and testicular biopsy, the latter only in experienced centers and when an assisted reproduction technique is planned.
Treatment of male infertility
Treatment is directed at the cause, and the choice depends on each patient. Some options are:
Surgery
Varicocele repair (varicocelectomy) and vasectomy reversal.
Medical treatment
Antibiotics, anti-inflammatories, and hormonal medications.
Assisted reproduction
Artificial insemination and in vitro fertilization, only in experienced centers.
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