Optimizing Male Fertility
The chance of an otherwise healthy couple conceiving is about 40% at 3 months, 75% at 6 months and 90% at 12 months. We recommend that couples that have tried to conceive without success after one year should seek care from a fertility specialist. Couples in which the female partner is over 35 years old should seek advanced care after 6 months of trying to conceive or if any known factor affecting fertility, such as diabetes or irregular periods, is known.
All patients will have a traditional semen analysis to assess their fertility. This is the most basic test and remains one of the single most important tests to assess male fertility.
Our approach to an individual’s fertility evaluation will focus on four aspects: Genetic, Hormonal, Lifestyle, and Physiology.
Genetic Fertility Testing
Our genes play a significant role in who we become and can play an important role in male fertility. A patient’s family history can give us incredible insight into factors that may influence a man’s ability to father children, especially as he ages. Especially in the azoospermic male (someone who has no sperm in his ejaculate), a genetic evaluation is a critical step to determine if infertility can be overcome.
The Genetic Fertility Tests We Offer Include:
Karyotype: This test will measure the number and type of chromosomes that a person has. Abnormalities in chromosome number and type can suggest certain forms of infertility.
Cystic Fibrosis Transmembrane Receptor Mutations: Although cystic fibrosis remains a relatively uncommon disease. Carriers of this genetic condition can exhibit a form of infertility that causes blockage of sperm from the testicle. This condition remains one of the most common genetic causes of infertility in men.
Y Chromosome Abnormalities: The Y chromosome determines a male’s gender from conception. This is also where genes that are specifically related to sperm production are located. Some abnormalities in the Y chromosome can be detected and can suggest forms of infertility found in azoospermia.The Y chromosome microdeletion test is a genetic test offered to our patients with severely low sperm concentration and is most useful in patients that have no sperm in their ejaculate. This condition is called azoospermia.
Counsyl™ Testing: For all of our patients we also offer genetic testing to help identify a variety of other genetic conditions that may be carried in the genome. Especially when done in conjunction with the partner potential genetic conditions can be uncovered that may affect children in the future.
Hormonal Fertility Testing
Hormones play a very important role in fertility of both men and women. Hormones are chemical signals released by special glands in the body that can have effects throughout the body and throughout our lives. The predominant sex hormone in men is testosterone, although estrogen and other hormones also play a role. We are able to measure the signals from the brain to the testicles that help regulate the production of testosterone and sperm (LH and FSH). In order to help repair any deficiencies that may exist we have a variety of medications that we can prescribe. A full hormonal evaluation will include measuring of prolactin, testosterone, estrogen, LH, FSH, thyroid function and a variety of other hormones. Normalization of hormone function is often the first step that we will undertake when we find male fertility difficulties.
The management of hormones in men who seek to retain their fertility is much more advanced than is usually performed by the traditional primary care physician or general urologist. It is critical that there is an avoidance of giving testosterone to men who hope to have children as this can significantly impair sperm production. Careful monitoring of hormone replacement in terms of potential side effects and effect is crucial in making sure that this is performed in a safe and effective manner.
Thyroid function is a well-known impactor of fertility in women and we believe that thyroid function should both be tested and normalized in men as well. We will also seek to normalize vitamin D levels.
Lifestyle Fertility Evaluation
The average sperm takes between 90 and 120 days to be produced, mature and then be ready to be ejaculated. This means that virtually anything that affects overall health can impact sperm function, maturity, and appearance, and can influence fertility for months, even after changes are made. Lifestyle factors can play a big role in male fertility. These can include smoking, excessive alcohol use, radiation exposure, obesity, and diet.
Our evaluation will help to uncover aspects of your lifestyle that may be impacting your fertility including activities you consider healthy, such as long-distance cycling or extreme dieting. We can help men who use tobacco to stop. We will assess alcohol use and offer recommendations on moderation. We have an in-house program to help men lose weight. And we will carefully personalize a supplement program based upon your diet, age, and fertility goals.
Physiologic Fertility Evaluation
Structural features of the testicle and medical conditions specific to a particular individual have the most obvious impact on fertility. Abnormal anatomy, abnormal blood flow, prior trauma, early childhood infections and congenital abnormalities can be discovered on a thorough genital examination. Certain features of the physical exam can also suggest causes of male fertility problems. The size and firmness of the testicles as well as the presence of any abnormally enlarged veins, called varicoceles, can suggest the cause of fertility problems. Any testicular masses or abnormalities in the formation of the penis that could interrupt normal semen deposition should be investigated. Also, there can be certain features of the body habitus that can suggest underlying genetic diseases that may prompt additional testing. When necessary, a testicular ultrasound may be performed.
Just as important as anatomy, however, is the possibility that medical conditions could be impacting fertility. This is a very commonly overlooked factor in most male fertility evaluations. Simply having an abnormal semen analysis is a risk factor for a man to develop cardiovascular disease early in his life. Elevated cholesterol, hypertension, and regulation of blood glucose all can impact fertility. Early identification of these problems, can impact both a man’s fertility as well as help him live longer.
Your cardiometabolic examination and our office will include a full physical examination as well as a full laboratory examination that often includes advanced lipid testing. We will assess your cardiovascular risk, measure your blood pressure and assess your risk for diabetes. This information will then be used to determine if an abnormal semen parameter could suggest an underlying cardiovascular disease as well as potential treatments that may be offered in conjunction with traditional fertility treatments to improve both fertility status as well as overall health status.