The male reproductive system is designed to manufacture, store and transport sperm — the cells that will ultimately fertilize a woman’s egg. Sperm production begins when immature cells grow and develop within a network of delicate ducts called seminiferous tubules inside the testicles. Sperm then matures while traveling through the epididymis, a coiled channel located behind each testicle. When climax, or orgasm, occurs, sperm are carried out through the vas deferens and deep in the pelvis where it mixes with semen produced by the seminal vesicle. This semen mixed with sperm then enters the area of the prostate where the urethra is. The semen is then ready to be expelled during ejaculation/orgasm.

Causes of Male Infertility

Infertility is typically caused by either a diminished production of sperm by your testicles or a blockage in the tubing that transports sperm from your testicle to the outside. Problems with production of sperm are typically triggered by genetic factors and a number of lifestyle choices (e.g., smoking, alcohol, and certain medications), all of which can impair the normal production of sperm cells resulting in a decreased sperm count. Long-term illnesses (e.g., kidney failure), childhood infections (e.g., mumps), chemotherapy/radiation and hormonal or chromosomal deficiencies (e.g., insufficient testosterone) can also account for abnormal sperm numbers.

One of the most prevalent sperm production problems, however, is linked to varicoceles; a worm-like bundle of dilated varicose veins around the testicles. They are found in about 15 percent of normal males and in approximately 40 percent of infertile men. Evidence suggests that by creating an abnormal backflow of blood from the abdomen into the scrotum, triggering a rise in testicular temperature, varicoceles hinder sperm production and cause low sperm count. Dr. Clavijo performs varicocele surgeries using a microscope for those patients with varicoceles and abnormal sperm counts, abnormal motility, or elevated sperm DNA damage. Of course, there are select patients who would not benefit from this surgery and not all need their varicoceles removed.

Diagnosis of Male Infertility

The problem usually falls in one of two areas — sperm production or delivery. In some cases, both sperm production and sperm delivery can be impared. The evaluation usually includes questions about your medical and surgical histories. The doctor will want to know about childhood diseases, current health problems, and medications (e.g., anabolic steroids) that might interfere with the formation of sperm. Lifestyle factors such as alcohol, marijuana, and other recreational drug use and exposure to occupational hazards such as ionizing radiation, heavy metals, or pesticides will also be important to know about.

Every evaluation will also include an assessment of your sexual performance, along with you and your partner’s joint efforts to achieve pregnancy. In addition to conducting a general exam, your doctor will look for any abnormalities of the penis, epididymis, vas deferens, and testicles during the genital exam. Your doctor provider will check specifically for varicoceles, some of which can be identified easily in the scrotum when the patient is standing (“bag of worms”).

The semen analysis is the most important lab indicator for male infertility. Your doctor will most likely ask you to provide results for at least two samples. These two samples help your doctor define each factor and its severity. In particular sperm concentration and motility (movement) allow your doctor to give you a much better picture as to what your ability to conceive is. A number of hormones, the most important of which are testosterone and follicle-stimulating hormone (FSH), regulate the process of sperm production and thus will also be checked with a blood draw. Taken together the combination of physical exam, semen analysis, and laboratory results (blood tests) will allow your doctor to define a sperm production or delivery problem that will guide treatment.