Male Fertility Overview

Evaluation of Male Fertility

Approximately 15% of couples have difficulty conceiving, and in these instances, male subfertility is the primary factor in 30% and a secondary factor in 20%. Therefore, the male is a contributing factor in 50% of infertility cases.

Fertility evaluation is traditionally recommended for couples who fail to conceive after one year of unprotected intercourse. Evaluation of the male partner should be performed first because initial exam and testing is non-invasive and less expensive than the fertility evaluation of the female partner.

The evaluation of the male partner begins with a thorough history to identify risk factors such as previous chemotherapy or radiation exposure, steroid, alcohol or other drug use, and injuries that could contribute to sub fertility. A physical exam seeks to identify anatomic abnormalities such as varicocele or an abnormal vas deferens. Basic laboratory testing that includes two semen analyses and blood tests for hormone abnormalities completes the initial exam. Once these results have been reviewed, the urologist will determine that male subfertility is or is not contributing to the couple’s failure to conceive. If male factor subfertility is confirmed, further testing (for example: more thorough evaluation of the endocrine system- see Hypogonadism this website) or treatment (for example: varix ligation) is indicated.

The most common reversible abnormality identified in males who appear subfertile is the presence of a varicocele- an abnormal dilation of the veins surrounding the testicular cord which contributes to increased temperature in the testes that interferes with normal sperm production and maturation. This is typically treated with surgical division of these veins that restores sperm count and motility in up to 70% of men.

Other less common abnormalities include: 1) obstruction of the vas or epididymis which requires microscopic surgery to bypass that obstruction or collection of sperm from the epididymis or testes for use in advanced reproductive technologies (ART) in conjunction with in vitro fertilization (IVF); 2) endocrine abnormalities which require hormone replacement therapy; 3) absence of sperm production which is usually untreatable.

The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.