Male Infertility Guide

Patients often ask questions about male infertility. We have compiled a list of the most frequently asked questions and separated them into related categories. View our comprehensive guide to male infertility below :

  • Understanding Male Infertility
  • Semen Analysis
  • Low Sperm Count
  • Increase Sperm Count
  • Sexual Intercourse and Conception
  • Vasectomy Reversal

Understanding Male Infertility

What is the official definition of male infertility ?

Male infertility refers to the inability to conceive a child, caused by factors that are not related to the female. Several factors can lead to male infertility, including low sperm production, immobile sperm, malformed sperm, or blockages that prevent sperm delivery to the semen. These conditions can result from illnesses, infections, chronic health problems, injuries and/or environmental factors, such as exposure to certain chemicals.

What is erectile dysfunction / impotence ?

Erectile dysfunction, also known as impotence, is an inability to get an erection that is good enough to achieve intercourse. The severity of erectile dysfunction can vary from complete lack of erection, to a partial erection that is not enough to penetrate your partner or is lost soon after you penetrate. Although erectile dysfunction is typically more common among older men, it can occur at any age.

What is premature ejaculation ?

Premature ejaculation happens when a man has an orgasm too soon during intercourse to satisfy his partner. The condition is typically caused by anxiety or too much stimulation, and is often more common during the early stages of a relationship. Premature ejaculation does not usually require treatment and improves on its own.

Is erectile dysfunction / impotence a cause or symptom of male infertility ?

Erectile dysfunction can cause male infertility because it interrupts or prevents intercourse. In order to conceive a child, sperm must be delivered to your partner’s egg during intercourse. Thus, problems that prevent or interrupt intercourse cause the inability to deliver sperm to the egg and lead to infertility. Having an erectile dysfunction does not mean you are infertile.

Is premature ejaculation a cause or symptom of male infertility ?

Premature ejaculation is another possible cause for male infertility. As with erectile dysfunction, premature ejaculation can prevent the delivery of sperm to the egg. This is especially the case when premature ejaculation occurs before penetration. However, if premature ejaculation happens during penetration, it may be sufficient enough to deliver sperm to the egg and cause fertilization. If you experience premature ejaculation, it does not mean you are infertile.

Can I experience male factor infertility even if my sperm count is healthy ?

Yes, you can experience infertility even if you have a normal sperm count. Male infertility can be caused by low sperm mobility, malformed sperm, as well as blockages in the sperm ducts that prevent the sperm from entering the semen. Even though your sperm count is normal, these other factors can cause infertility.

Does viagra affect male fertility? Will viagra increase or decrease sperm count ?

Viagra has not been proven to affect male fertility. There is no medical studies that viagra helps male fertility or has the ability to modify sperm count. Viagra can improve your ability to have and maintain an erection, which does help your ability to have intercourse. However, if you have been trying for more than 1 year with your partner to conceive without success, an appointment with your urologist is recommended to explore male factor infertility.

Semen Analysis

Does a semen analysis hurt ? How is this procedure performed ?

Semen analysis is a pain free procedure that measures the amount and quality of a man’s semen and sperm. In order to do the analysis, you’ll need to provide a sample of your semen. This can be done by collecting a semen sample into a sterile container during masturbation, or by using a special condom that collects the sample during intercourse. Once you deliver the sample to your health care provider they will run the analysis in a laboratory.

Is sexual intercourse or masturbation off-limits before a semen analysis ?

You should avoid all sexual activity for two to three days before having the semen analysis. Sexual activity leads to ejaculation, which can lower your sperm count temporarily and affect the test results. On the day of the test, you need to collect the sample and then deliver it to the laboratory within two hours for the most accurate results.

Why are the results of my current semen analysis different from my original semen analysis ?

Men’s ability to produce viable and healthy sperm can change considerably over the years. This can be caused by several factors including aging, exposure to certain chemicals, infection and certain illnesses. There are also factors that can temporarily lower your sperm count, such as stress. Thus, it is fairly common that your current semen analysis differs from one done a few years back. Minor differences can also be accounted for due to varying techniques used in different laboratories. However having an analysis performed in one laboratory versus another, should not create a significant enough difference to affect the results of a normal vs. abnormal semen analysis.

Low Sperm Count

What is the sperm count for healthy semen ?

Normal sperm count is typically between 20 to 150 million sperm per milliliter of semen. In addition, at least 60 percent of the sperm should have normal motility and shape. However, these values can slightly vary depending on the laboratory that analyzes the semen sample.

If I have a low sperm count, am I infertile ?

Low sperm count is one of the leading causes of male infertility. Although low sperm count decreases you and your partner’s chances of conceiving a child through intercourse, it does not mean you cannot father a child.

What infertility treatments are recommended for low sperm count ?

The treatment options for low sperm count depend on the underlying causes for the condition. For example, if low sperm count is caused by swelling of the veins that drain testicles, or blockage of the sperm ducts, these can be treated with surgery. If the condition is caused by infection or hormonal imbalances, these can be treated with certain medications. In some cases the low sperm count can’t be treated and the only option for you to father a child is to use assisted reproductive technology (ART). This is done by taking the sperm directly from the testicle and then artificially injecting it into the egg. In vitro fertilization (IVF) is the most common ART treatment.

Can an STD cause low sperm count ?

Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, can cause low sperm count. These infections can interfere with sperm production and cause scarring that blocks the passage of the sperm. STDs can be treated with antibiotics, and treatment usually returns your sperm count to normal. Untreated STDs can lower your sperm count permanently.

Can excessive drinking of alcoholic beverages cause low sperm count ?

Excessive drinking can lower your testosterone levels and decrease sperm production, leading to low sperm count.


Increase Sperm Count

Can certain types of underwear increase or decrease my sperm count (boxers vs. briefs) ?

Wearing tight underwear holds your testicles close to your body, which causes pressure and increases the temperature in your scrotum. This can lead to reduced sperm production. If you have a low sperm count, your health care provider may recommend you start wearing boxers and/or other loose clothing to increase your sperm production.

Can regular exercise and a healthy diet increase my sperm count ?

Regular exercise helps maintain weight and reduce emotional stress. Both stress and being overweight can negatively affect sperm quality and count. Thus, managing your weight and stress level with healthy diet and exercise can have a positive effect on your sperm count.

Does masturbation increase or decrease my sperm count in any way ?

Masturbation will typically lead to ejaculation. Although this won’t have any long term effects to your sperm quality or count, it does affect your sperm count temporarily. Every time you ejaculate you will lose sperm from your body. If you and your partner are trying to conceive, regular masturbating can lower your sperm count and make it more difficult to get pregnant. It is best to avoid masturbation during the period of time you and your partner are trying to conceive a child.

Will avoiding extreme heat such as laptops in my lap and hot tubs help increase my sperm count ?

Hot tubs and a heat emitting laptops can increase the temperature in your scrotum. Even a slight increase in temperature can have a negative effect on your sperm production. If you and your partner are trying to conceive, it is better to avoid hot tubs, sauna’s and other heat sources, such as heating pads and laptops.


Sexual Intercourse and Conception

Are some sexual positions more conducive to getting pregnant than others ?

There is no scientific evidence supporting a claim that some sexual positions are more likely to lead to conception. Some positions, such as missionary, may deliver the sperm closest to the cervix, but whether this increases your chances of getting pregnant is not well understood. Timing intercourse properly during ovulation is more important than the position when trying to get pregnant.

How many times per week should we have sex to get pregnant ?

When it comes to getting pregnant, having intercourse more often is not necessarily going to increase your chances of conceiving. Women are fertile only five to ten days during their monthly cycle – just before and during ovulation. Having intercourse on other times during the monthly cycle will not lead to pregnancy. In addition, having sex several times per week can actually lower your sperm count and decrease your chances of getting pregnant. To increase your chances of getting pregnant, you should have sex few days before ovulation and then on the day of ovulation, and limit sexual activity other times during this fertile time period.

Can tracking ovulation help our chances of getting pregnant ?

Tracking your ovulation is essential when trying to get pregnant. Ovulation occurs when a women release a mature egg from the ovary to the fallopian tube, making it available for fertilization. The released egg is only viable for 12 to 24 hours after leaving the ovary, and fertilization must occur during this time period in order to achieve pregnancy. Unlike the egg, sperm can survive days in the fallopian tubes, waiting for the egg to arrive. Tracking your ovulation will help you determine the best days during your monthly cycle to get pregnant. The best days to have intercourse are a few days following ovulation and on the day of ovulation.


Vasectomy Reversal

I had a vasectomy over 10 years ago – is it still possible to reverse my vasectomy successfully ?

Yes, vasectomy surgeries performed over 10 years ago can still be reversed successfully. Vasectomy reversal is a surgical procedure that re-connects the tubes that carry sperm from the testicles into the semen. Vasectomies performed as long as 30 years ago have been reversed successfully. The potential for a successful vasectomy reversal is partially dependent on the quality of the original vasectomy as well as the experience level of the vasectomy reversal microsurgeon. Many urologists perform reversals only several times a year. It is best to find a specialized microsurgeon that performs vasectomy reversals regularly each week.

How long will it take for sperm to return to my ejaculate after a reverse vasectomy ?

Sperm usually returns to the semen within a few months. However, during the first few months your sperm motility may be poor even if your sperm count is good. It usually takes around six months to achieve normal sperm count and improved sperm motility.

How soon can I have sex after a vasectomy reversal ?

It is recommended you wait at least three weeks after the surgery before resuming your normal sex life.

Is there a lot of post-op pain after a vasectomy reversal ?

The post-op pain after a vasectomy reversal is very similar to the pain after the original vasectomy surgery. Normal symptoms include soreness, slight swelling and bruising of the scrotal area. Any discomfort you experience can be alleviated with pain medications.

If my partner gets pregnant after a vasectomy reversal, are there added risks involved ? Is the sperm just as healthy as it was before my original vasectomy surgery ?

There is no added risk for the outcome of pregnancy. Sperm itself is unchanged by the vasectomy reversal; the only thing that differs is the ‘age’ of the sperm.

Will my sex life be affected after a vasectomy reversal ?

Your sex life should remain the same. Some men even find their sexual life enhanced after vasectomy reversal because it’s “the real thing”.

What are vasectomy reversal alternatives ?

Instead of having a vasectomy reversal, you may consider an operation called intracytoplasmic sperm injection, or ICSI. For men with a vasectomy, ICSI involves retrieval of sperm from the epididymis or testis with a minor surgical procedure. It is done under local anaesthesia and involves an insertion of a needle into the scrotum to retrieve the sperm. ICSI is used in combination with in vitro fertilization to achieve pregnancy. During the operation, one single sperm is injected into an egg obtained from your partner. The fertilized egg is then transferred into your partner’s uterus, after which pregnancy can continue normally.When is ICSI better than a vasectomy reversal ?

ICSI can be a better option compared to a vasectomy reversal when time is a major concern, and if you only want to have one child. ICSI is less complicated than vasectomy reversal and requires only a minor surgical procedure. In addition, since your vasectomy is not affected, you remain sterile and do not need to consider any other birth control methods. ICSI can also be more successful way to achieve pregnancy if you and/or your partner have infertility issues.


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