Male Infertility Treatment in Indianapolis, IN

Infertility affects roughly 15% of couples trying to build their family. Defined as the inability to achieve pregnancy after 12 months of unprotected intercourse, infertility can have contributing factors from both the female and male partners.

Although most people tend to think of infertility as a female problem, research has shown that there can be a contributing male factor up to 50% of the time. This reality means that half of the couples struggling to achieve pregnancy will have some contributing male factor! That’s why it’s so important that both the female and male partners undergo a fertility evaluation if there are concerns.

Compared to the female fertility evaluation, checking a man’s fertility is usually simple and non-invasive. There are 3 key tests that almost all men seeking to have their fertility checked must obtain:

1) At least 2 recent semen analyses (also known as sperm counts)
2) A lab draw to check hormone levels
3) A thorough history and non-invasive physical exam

Occasionally more tests are needed and these are collected on an as-needed basis. However, for most men, these 3 key tests are all that is needed to assess their fertility potential.

Once these have been obtained, a treatment plan can be established. This treatment plan may involve lifestyle changes, the use of medications, and sometimes minimally-invasive procedures for men that require them.

Lifestyle Changes and Medication

Simple lifestyle choices can have a profound impact on a man’s fertility potential. Obesity, poor diet, and lack of exercise have all been shown to contribute both to male infertility and low testosterone levels. Other significant causes of male infertility include tobacco, alcohol, cannabis, and other drug use.

Male infertility has often been described as the ‘canary in the coal mine’ of Men’s Health. This means that infertility may be the first symptom that men experience as the result of poor lifestyle choices long before other problems appear like high blood pressure, heart disease, and diabetes. As a result, we encourage all men who are seeking to improve their fertility to improve their lifestyle.

In addition to lifestyle changes, medication can often be beneficial to certain men seeking fertility treatment. These medications are typically designed to optimize a man’s hormone levels.

Varicoceles

A varicocele is an enlargement of the veins that drain blood away from the testicle back up to the heart and lungs. They are extremely common and can be found in about 15% of men. Varicoceles typically develop during puberty and are the result of the internal valves inside these veins failing. When these valves work like they’re supposed to, they stop oxygen-poor from flowing ‘backward’ away from the heart. But when they fail, gravity pushes this blood ‘down’ and causes it to pool around the testicles inside the scrotum. This blood is hot and can then raise the temperature of the testicles. This elevation in temperature can then cause problems for a select subset of men with varicoceles.

Although most men with varicoceles will not experience any problems related to them, the increase in temperature caused by these dilated veins can have a significant impact on fertility in approximately 1 in 5 men found to have them. For these men, varicocele repair has been shown to significantly improve fertility in approximately 60-70% of cases. When performed microscopically by a fellowship-trained expert, varicocele repair is a safe, minimally-invasive, same-day procedure with very little discomfort.

What We Do When There’s No Sperm

A complete lack of sperm in the ejaculate, a condition known as azoospermia, is the most profound form of male infertility. Typically, azoospermia is a result of one of three possibilities:

1) A plumbing problem

Known as obstructive azoospermia (OA), a ‘plumbing problem’ means that the testicles make sperm, but the tubes that carry them away from the testicle are blocked. This issue could be caused by prior surgery (like an injury during hernia repair) or it could be the result of a condition a man is born with.

2) A partial production problem

Known as non-obstructive azoospermia (NOA), a ‘partial production’ problem means that man may produce sperm, but it’s made in a small amount that it can only be found inside the testicles themselves and not in the ejaculate. An example of men who can have this version of NOA include men with Klinefelter’s syndrome.

3) A complete production problem

Also known as non-obstructive azoospermia (NOA), a ‘complete production’ problem means that the man in question doesn’t make any sperm and never will. Two very specific examples of this are men who possess AZFa and AZFb Y chromosome microdeletions, known genetic causes of male infertility.

Distinguishing between these different types of azoospermia is a complex process that usually requires a more thorough evaluation than the initial 3 key tests described above. Most men who don’t have sperm in their ejaculate will benefit from special genetic testing in addition to the usual hormone checks we perform for all men. It should be noted that there are some causes of azoospermia that don’t require this sort of testing. Examples of these men include men who are currently taking or have recently taken, testosterone or other anabolic steroids and men who have previously undergone vasectomy.

To learn more about how we evaluate men who don’t have sperm in their ejaculate and the sperm retrieval procedures we commonly perform, please see our educational video below from Dr. Alex Tatem.