Public opinion still sees infertility as primarily a woman’s issue. When fertility treatments are covered in the media, the articles and features you see are almost always written by and directed at women. The stories you hear through the grapevine are usually from a woman’s point of view. If men are mentioned in relation to infertility at all, it is often as an afterthought.

In reality, male infertility is much more common than most people think, and the emotional impact of struggling to conceive is just as real for men. On average, one out of three cases of infertility is actually caused by male factor infertility, and many more are caused by a combination of infertility issues in both the male and female partners: male infertility is involved in about half of all cases. There are many strategies that may improve semen analyses and it is important to discuss with your doctor.

What are the available treatments for male infertility?

Although up to half of all cases of male infertility are due to unknown causes, starting with a full diagnostic workup is crucial. A physical exam, STI screening, semen analysis, hormone and genetic testing can all help you and your doctor narrow down the options. Even if the exact reason for a man’s infertility cannot be pinpointed, these tests can rule out potential issues and point the way to a treatment plan.

Fertility doctors have a wide range of options to choose from when treating male infertility. Both surgical and non-surgical treatments can be used to resolve or overcome problems with a man’s reproductive function.

Non-surgical treatments for male infertility

• Medication: If a man’s infertility is caused by hormone imbalances, issues with erectile dysfunction, or an untreated infection, it may be resolved with the help of medications.

• Sperm retrieval: For men with exceptionally low sperm counts, those who seem to be producing no sperm in their ejaculate, or those who are unable to ejaculate, sperm retrieval procedures can allow a doctor to retrieve sperm from within the body. There are several methods commonly used for sperm retrieval:
  • microsurgical epididymal sperm aspiration (MESA)
  • percutaneous epididymal sperm aspiration (PESA)
  • testicular sperm aspiration (TESA)
  • testicular sperm extraction (TESE)

• Electroejaculation Therapy (EEJ): In spite of a rather startling name, EEJ is a non-invasive and painless treatment for men who produce sperm normally but cannot ejaculate. It is performed on an outpatient basis and under local anesthesia in a procedure that takes around 30 minutes.

• Intrauterine Insemination (IUI): Sometimes referred to as “artificial insemination”, IUI can be helpful for several different male infertility issues, particularly those where sperm motility and mobility are low. In IUI, a sperm sample is carefully treated and “washed” in a lab to create the highest possible concentration of healthy, active sperm. It is then placed in the ovulating woman’s uterus during using a thin catheter to give it the best chance at fertilizing an egg.

• In Vitro Fertilization (IVF): is a highly effective option for many cases of male infertility stemming from a wide range of issues. IVF takes place in a specialized fertility lab. Using a sperm sample and mature eggs retrieved from a woman’s ovaries, fertilization takes place under controlled conditions. The resulting embryos are then cultured and watched in the lab. The healthiest and most viable are chosen and transferred into the woman’s uterus, where they can implant. IVF can be used alone or with other advanced Assisted Reproductive Technologies (ART) such as ICSI.

• Intracytoplasmic sperm injection (ICSI): In severe cases of male infertility where there are very few healthy sperm cells available, ICSI can be an incredibly effective treatment. In a fertility lab, individual high-quality sperm cells are injected directly into individual mature eggs in order to fertilize the eggs for use in IVF.

Surgical treatments for male infertility

• Ejaculatory duct resection: Blocked ducts are a relatively common cause of male infertility, but they can sometimes be cleared by a surgeon. This is a short, hour-long surgery performed on a day patient basis, under local or general anesthesia.

• Varicocele repair: Surgery to repair varicoceles (varicose veins) in a man’s scrotum could create a more hospitable environment for sperm. Surgical varicocele repair is a minor outpatient procedure. The effectiveness of this procedure is no conclusively proven, but theoretically it may improve sperm count, motility and mobility.

• Vasectomy reversal: If a man has previously undergone a vasectomy but now wishes to conceive, it may be possible to reconnect the vans (or tubes) in a minor surgical procedure conducted under spinal or general anesthesia. The possibility and effectiveness of vasectomy reversal largely depends on which technique was used in the original vasectomy and length of time since that procedure.

Breaking the stigma around discussing male infertility is important. Infertility can be a devastating experience for everyone. As a man, the shame and stress of not being able to father a child when they are ready is often acute. Feelings of guilt about not being able to “give” their partner a child are common. If you suspect that you or someone you care about may be dealing with male factor infertility, don’t be afraid to talk about it, and don’t wait to seek help. Men deserve to know that they are not alone in their struggle with fertility, and that there are treatments available which can be life changing.