Infertile is the term used for couples who are unable to become pregnant after at least a year of attempts. Infertility affects approximately 15% of couples. Of those couples, males are a source of infertility in 50%, and a male factor only is present in 30% of infertile couples. Infertility is a complex problem and both male and female need a medical evaluation to try to determine the cause.
In most cases, male infertility is due to low sperm count or abnormal sperm production, which can result from low testosterone, genetic defects or infection. Men with undescended testicles or varicose veins in the scrotum may have sperm production impaired by the resulting higher temperature in the testicles.
Infertility can also result from problems delivering the sperm into the vagina. This may be caused by problems with sexual intercourse or by a physical defect, such as a misplaced urinary opening, blockage in the testicles or sperm-carrying ducts that are missing or blocked. A variety of conditions can cause retrograde ejaculation, in which semen enters the bladder rather than emerging from the penis. Disease or injury to the spinal cord may cause inability to produce semen, and vasectomy occasionally results in production of antibodies that weaken or disable sperm.
Treating infertility requires evaluation of both partners. You should see a urologist and your partner should consult her gynecologist.
Your doctor will probably begin with a thorough physical exam and discussion of your medical history and sexual habits. A blood test will be done to determine the level of testosterone and other male hormones. Two separate semen samples will also be analyzed for quality and quantity of sperm and to detect any presence of blood or infection. Ultrasound may be used to reveal problems, such as obstructions or retrograde ejaculation.
Treatment of male infertility varies, depending on what cause is found. You may be advised to make lifestyle changes, including changing the frequency of intercourse.
Medication or surgery may be used to correct physical problems, such as low sperm count, that interfere with fertility. If abnormal semen is found, technological methods may be used to bring egg and sperm together. These include artificial insemination and in vitro fertilization.