Male Infertility Chattanooga, TN
How Common is Male Infertility?
About 15% of couples are unable to get pregnant during the first year of unprotected intercourse. In one-third of couples, the man and woman contribute equally to the difficulty conceiving, and in another third of couples, only the man contributes to the infertility. Men who contribute to the difficulty conceiving usually have some abnormality in sperm production or delivery that can be identified on a male fertility evaluation. For a male fertility evaluation contact our Chattanooga, TN office, we also see patient from Knoxville, Northern Georgia & Huntsville, AL.
What are the most common causes of male infertility?
Male infertility can be traced to a number of causes, but it really comes down to the sperm. Some physical problems prevent the sperm from being ejaculated normally in semen. Other problems affect either the quality of the sperm or the production of the sperm
Though the range of possible causes behind male infertility is too great to cover at length here, these are some of the possible causes:
- Blockages or physical damage — Sometimes a man is born with a blockage in the testicle or other issues that prevent sperm from getting into the semen. Physical trauma to the testicles, prostate, and urethra can play a role here, too.
- Retrograde ejaculation — When a man has this disorder, the semen doesn’t come out of the penis during ejaculation, but instead enters the bladder.
- Varicoceles — These are enlarged varicose veins that develop in the scrotum and prevent blood from flowing properly. Varicoceles are found in 15 percent of all men, and up to 40 percent of infertile men.
- Sexually transmitted diseases — Infections such as gonorrhea or chlamydia can cause infertility in men.
- Autoimmune problems — If your body mistakenly sees sperm as foreign bodies, your immune system will attack them.
- Sexual problems — Erectile dysfunction and premature ejaculation obviously affect fertility, or at least the ability to conceive. Reasons behind these problems can be psychological or can be rooted in physical conditions such as diabetes, high blood pressure, and heart disease.
- Excessive exercise — Too much exercise causes the release of too many steroid hormones, affecting fertility.
- Use of drugs and alcohol — The use of marijuana, cocaine, steroids, alcohol, and cigarettes can reduce sperm counts.
- Environmental exposure — Exposure to environmental hazards such as pesticides, radiation, mercury, and others lower sperm counts.
- Stress and obesity — Both lower sperm counts and affect sexual activity.
- Heat — There is also evidence that excessive heat from the frequent use of saunas or hot tubs can temporarily lower a man’s sperm count.
Does genetics play a role in male fertility?
Changes to chromosomes and genes can cause abnormal sperm production or blockages to sperm flow. The most common genetic causes of infertility are chromosomal conditions that affect sperm production. These include:
- Klinefelter syndrome
- Y chromosome deletions
- Other genetic problems, such as Down’s syndrome
When Should Evaluation for Infertility Be Performed?
A couple is considered to have fertility problems after 1 year of unprotected intercourse without getting pregnant. After a year of trying to conceive, the couple may consider seeking an evaluation of the male and female partners. There are several reasons the couple may undergo an evaluation sooner, including a history of male anatomy variations such as undescended testis, advanced maternal age (female partner >35 years old) or if the couple’s fertility is under question for any reason.
Importance of Male Infertility Testing
One of the most common misconceptions is that the man in the couple does not contribute to the infertility equation. As stated above, the man can contribute to infertility in the couple about 25-75% of the time. It is necessary in most situations that the man be fully evaluated unless a semen analysis is completely normal.
Part of the reason most non-specialists may not consider this important is because most men will not have symptoms of having fertility issues. Sometimes erectile/sexual dysfunction, prostate problems and trouble urinating or hormonal issues will hint at fertility issues. However, most men will not be identified as having fertility issues until fully evaluated by a specialist.
More recently we have come to realize that during the evaluation of male infertility many other more sinister things can be found. It is not uncommon to find testicular cancers, genetic disorders that may be passed onto offspring, anatomic abnormalities such as missing kidneys, and hormonal imbalances. Often the male fertility evaluation will be the first evaluation of the fully matured man by a physician since adolescence. This visit may refocus the individual towards improvements in general health, and lifestyle even if no male fertility issue is identified.
How Men are Evaluated for Infertility
A comprehensive medical, fertility, and sexual history will be requested prior to your visit via a questionnaire. Your replies will be reviewed at your visit. This evaluation will involve your partner and assess her fertility status as well. You will receive a focused physical exam. Two semen analyses should be performed prior to your evaluation to maximize the counseling at the end of the evaluation. The semen analysis will determine your sperm quality and sperm count. Two semen analyses are required to establish a baseline since semen counts can vary greatly even in normal individuals without fertility issues.
Hormonal testing will determine whether the proper environment to make and mature sperm exists. Other genetic testing, or semen retrieval methods may be needed depending on your initial evaluation.
Which Partners Should Be Evaluated for Infertility First?
Most male reproductive experts agree the male should be evaluated first. This may seem self-serving but the reasons behind it make sense.
Usually two ejaculated semen analyses and hormonal analysis are obtained during the evaluation of the male. The female partner will receive blood work, a transvaginal ultrasound, and hysteriosalpingogram (HSG) –a test where dye is placed within the uterus. The male’s workup is less invasive. And, the initial male evaluation costs less.
Significant improvement and changes in the fertility status of males take at least 3 months, compared to less time for women. Given the increased interval of time required in the man to notice improvement, it may be beneficial to start the male work-up first or simultaneously in couples with a partner >35 years of age.
One caveat to this if the couple wants to conceive as quickly as possible via in-vitro fertilization. IVF does not require improving the man’s fertility in 9 out 10 cases. Furthermore, there is minimal invasiveness for the man and minimal time spent achieving pregnancy, if successful. Nevertheless, this does not minimize the importance of a male factor evaluation as a way to promote general men’s health and to identify more morbid diseases that could be causing sperm dysfunction.
Is there anything I can do to improve my fertility?
There are lots of tips out there on increasing your sperm count, which is the basic goal of improving your fertility. Here are a few things you can do on your own to increase your sperm count:
- Exercise and sleep more — Studies have suggested that weight loss among overweight or obese men can lead to an increase in sperm count.
- Quit smoking — Various studies have shown that cigarette smoking consistently reduces sperm count.
- Avoid excessive alcohol use and drug use — It’s difficult to have lots of research here, due to ethical issues with drug use, but there is evidence that drug use and excessive alcohol intake can decrease sperm production.
- Pay attention to the medications you are on — Many medications can decrease healthy sperm production. This is usually a temporary issue (when the medication is stopped sperm production returns to normal), but it could be worth noting. These drugs can decrease sperm count: anti-androgens, anti-inflammatories, antipsychotics, opiates, antidepressants, anabolic steroids (these affect sperm count for up to 1 year after stopping), supplementary testosterone, and methadone
- Take fenugreek — There is a possibility that supplements made from fenugreek seeds can improve sperm quality and sperm count.
- Get enough vitamin D — Research shows low blood levels of vitamin D and calcium appear to impact sperm health.
- Take ashwagandha — Indian ginseng has long been used in traditional medicines as a remedy for sexual dysfunction.
- Eat more antioxidants — Antioxidants are molecules that help deactivate compounds called free radicals. Free radicals damage cells, including sperm cells. Foods that are rich in antioxidants help.
- Eat better fat — Polyunsaturated fats are crucial for the healthy development of the sperm membrane. These fats include omega-3 and omega-6. You can take these as supplements or get them in foods such as salmon. At that same time eat less trans fatty acids, as these decrease sperm count.
- Limit soy and estrogen-rich foods — Some foods, especially soy products, contain plant estrogen. This has been shown to possibly reduce testosterone bonding and sperm production.
- Get more folate and zinc — Studies have shown that folate and zinc in combination may improve sperm health and concentration.
Can male infertility be treated? How?
We can’t always pinpoint the cause of a patient’s infertility, but that doesn’t mean it can’t be treated. In over half of the cases of male infertility the problem can be corrected. These are some of the treatment options Dr. Shridharani may utilize:
- Surgery — Varicoceles can be surgically corrected. Sometimes blocked pathways in the testicles can be opened.
- Treating sexual dysfunction — We can provide medication or counseling to overcome erectile dysfunction or premature ejaculation.
- Treating infection — We may use antibiotics to cure an infection in the reproductive tract.
- Hormone treatments — If infertility is caused by high or low levels of certain hormones, we can work to balance those out.
- Assisted reproductive technology — Through methods such as surgical extraction of sperm, we can then insert the sperm into the female genital tract or use it for in vitro fertilization.
What are the differences between male infertility, impotence, erectile dysfunction, and premature ejaculation?
Sterility (the absence of sufficient sperm) and impotence (trouble getting or maintaining an erection) are quite different but both impact successful reproduction. Sterility means there are not enough sperm in the semen, so intercourse cannot deliver the sperm to the female’s egg. Impotence makes having intercourse difficult or impossible, thus having the same effect. Impotence and erectile dysfunction are considered to be the same thing.
Premature ejaculation is simply the man ejaculating sooner than he or his partner would like. If this happens prior to intercourse, the sperm cannot get to where they need to go. You could have premature ejaculation during intercourse, and this would not impact fertility. Premature ejaculation can typically be overcome with behavioral changes and exercises. Just because a man is prone to premature ejaculation doesn’t mean he is infertile in any way.
My experience was very good with Dr. Shridharani. This was my first appointment but he was very kind and he took the time to go over systems and provided a plan to move forward. I would recommend Dr. Shridharani to men looking for a knowledgeable professional that listens to you.
Hi, my name is Holly Day. My husband Justin and I were having trouble conceiving for over 2 years. After Justin’s surgery with Dr. Shridharani in December of 2014, we are now expecting a baby in January 2016. This wouldn’t have been possible without him, so for that we are extremely grateful. He is truly an amazing doctor and works is a very professional manner. Hopefully our success will be encouraging for others facing fertility problems! Thanks again for everything Dr. S!!
Schedule a Consultation with Dr. Shridharani
Dr. Shridharani provides Chattanooga and Knoxville TN, Northern Georgia, Huntsville AL and the surrounding areas with advanced treatments for male infertility. Call (423) 778-4MEN (4636) or visit our contact us page to schedule an appointment today!