Male Fertility

Infertility is recognized as a medical condition by the World Health Organization (WHO), as well as many other professional societies including the American Medical Association (AMA), the American Society for Reproductive Medicine (ASRM), and the European Society of Human Reproduction and Embryology (ESHRE).^i,ii,iii,iv

Estimates of infertility frequency vary worldwide and even differ depending on the way data is collected. Prevalence is the term used to describe how common a medical condition is in a particular population. According to the U.S. National Survey of Family Growth, the prevalence of infertility in married heterosexual women aged 15 to 49 is approximately 19.4 percent.^v Estimates in the U.K. for a similar population were 12.5 percent.^vi Some studies indicate that the prevalence of male infertility is 10 to 15 percent, but these estimates may not be accurate due to the lack of quality evidence.^vii

Klinefelter syndrome (KS) is a genetic condition in which a male is born with an extra X chromosome. This condition often impacts fertility (potentially in addition to other aspects of health and development), though it does not necessarily mean a person cannot have biological children. By understanding the symptoms, causes, risks, and treatments, individuals with Klinefelter syndrome can better navigate treatment options.

Varicocele is a relatively common condition affecting the male reproductive system. Though not all varicoceles cause problems, they can sometimes lead to issues such as testicular pain, decreased sperm count, and decreased sperm quality that can affect fertility. For these individuals, varicocele treatment can help.

While both males and females can experience sexual dysfunction that affects fertility, erectile dysfunction (ED) in males is one of the more common and problematic concerns. The physical aspect of ED can mean an inability to perform during intercourse, as well as an impeded ability to deliver sperm. However, ED can also be a sign of other health problems and may lead to emotional distress, especially when trying to conceive.

Understanding what causes erectile dysfunction, who may be most at risk, and how it can be treated are all critical elements for reaching one’s fertility goals.

Sperm, or spermatozoa, are the reproductive cells (gametes) of a biological male. The reproductive cell of a biological female is called an oocyte, ovum, or egg.

The primary function of sperm is to reach and fuse with an egg. This process allows the sperm to deliver male genetic information (DNA) into the egg. In doing so, a zygote (fertilized egg) is formed, which can then go through stages of development to form a fetus.

Human DNA is contained within structures called chromosomes, which are found inside the nucleus of every cell. Most human cells are diploid cells, meaning they contain two sets of 23 chromosomes — one set from the sperm and one set from the egg that made them. Sperm and egg cells, however, are haploid cells, and contain a single set of 23 chromosomes. When a sperm fuses with an egg, the newly formed zygote will have two sets of chromosomes, one from the sperm and one from the egg. This fusion is how most human cells end up with a total of 46 chromosomes.

Sperm production occurs inside male testes (also called testicles). Unlike biological females, who are born with all the eggs they will ever produce in their lifetime, biological males’ sperm production begins once they reach puberty, and they will continue making sperm throughout their lifespan.

Sperm retrieval procedures are used to remove sperm from the testicles for the purpose of fertilizing an oocyte (egg). They may be used for males who have zero sperm count in their ejaculate (azoospermia) but still produce sperm in the testes.

There are two main techniques for surgical sperm retrieval: aspiration and extraction. Sperm aspiration involves using a needle to aspirate (remove) sperm from the epididymis or the testes. Testicular sperm extraction takes a sample of the tissue, known as a biopsy, to collect the sperm. There are also different variations or subtypes of these procedures, as well as non-surgical approaches for individuals with ejaculation limitations.

Though a vasectomy used to be considered a permanent sterilization procedure, modern developments have made reversal possible. This article will explain various vasectomy reversal procedures and the likelihood of success in restoring fertility. It will also review alternative fertility options.

It is estimated that male infertility is the sole cause of 20 to 30 percent of infertility cases, and a contributing factor in approximately half of infertility cases.ⁱ Sperm defects, including a type of sperm DNA damage known as sperm DNA fragmentation (SDF), are a leading cause of male factor infertility. Doctors and researchers are still learning about SDF, including how it impacts fertility, what causes it, and how it can be treated.

Sperm donation is a process in which a fertile male donates semen (ejaculatory fluid containing sperm) that can be used by an individual or couple wanting to have a baby. An understanding of how sperm donation works, what its success rates are, and why people might opt to use sperm donation, are helpful in determining how that fertility journey might look.