Infertility is defined as the inability to conceive after one year of unprotected, properly timed intercourse. Approximately 15% of all couples are infertile, and around 50% of male partners will have an identifiable factor impairing their reproductive potential; 20% to 30% of couples will not be able to conceive naturally solely because of a male factor.
Traditionally, couples sought evaluation after trying to conceive for one year. However, many couples are now postponing parenthood until they are older, so it is suggested that couples seek evaluation earlier if they have any concerns about their fertility.
Early evaluation of the male partner is important for the following reasons:
- To optimize overall fertility potential and maximize chances of natural or assisted pregnancy.
- To prevent unnecessary added delays, since many couples are now postponing parenthood.
- To screen for modifiable practices or lifestyle elements that might be affecting male fertility.
- To identify treatable causes of male infertility.
- To screen for undetected medical conditions that might be contributing to male infertility.
There can be many causes for male infertility. Therefore, we advocate a systematic approach which begins with a detailed history and physical examination, followed by a thorough laboratory evaluation. The initial evaluation includes a semen analysis and hormonal testing. Depending upon these results, a more detailed evaluation may follow with:
- Repeat semen analyses
- Sperm function tests
- Additional hormonal studies
- Radiologic studies
- Genetic evaluation
- Testicular biopsy
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To schedule an appointment at Johns Hopkins Green Spring Station, call 410-955-6100.
To schedule an appointment at Johns Hopkins Bayview Medical Center, call 410-550-7008.
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Undetected medical conditions
Male infertility can often be the first sign of other undiscovered health conditions. Furthermore, healthy men with infertility are at an increased risk of certain medical conditions later in life. Studies have found significant medical conditions in up to 6% of infertile men that were thought to be healthy, and the risk seems to correlate with semen and hormonal abnormalities. See below for more information about various medical conditions and their relationship to male infertility, such as testicular cancer, testosterone deficiency, prostate cancer and other hormonal issues.
Testicular cancer affects 1 in 250 men and is most common in men of reproductive age. Both testis cancer and infertility are associated with poor development of the testes, and testis cancer itself can directly cause infertility as well. Studies have found the risk of testis cancer in the setting of semen abnormalities can increase by as much as 18 fold. Thus, all infertile men need a proper physical exam at initial evaluation, and they should perform monthly testicular self-examination (TSE).
Aside from causing infertility, testosterone deficiency or low testosterone can cause symptoms such as fatigue and decreased libido. Low testosterone levels are also associated with multiple other health concerns, including heart disease, abdominal obesity, and osteoporosis.
Recent studies suggest a possible link between infertility and prostate cancer. Specifically, it seems that infertility might confer an even higher risk of developing aggressive prostate cancer than a family history of the disease. Since prostate cancer typically affects men past the reproductive age, it is important for infertile men to understand the importance of proper screening once they get older.
Other hormonal problems can be caused by certain health conditions. Diabetes, thyroid problems, and small pituitary tumors in the brain can all cause disruption of sperm parameters and hormonal balance – even in the absence of symptoms. When initial evaluation raises clinical suspicion for such conditions, extended testing is indicated.