Talking About the Difficult Stuff: What You Need to Know About Male Infertility

Just being there means a lot to your man when it comes to dealing with male infertility. Credit: Liz Grace

Male infertility may be a men’s health issue, but did you know that the majority of the time women take the first steps in seeking help if they’re having troubles getting pregnant? Yeah, not surprising. (What is it with men and doctors?!) But, the subject of male infertility can be tricky—and potentially embarrassing for both people in the relationship.

Seeing that my husband just got tested as part of our ongoing infertility journey, I wanted to take time out to talk about male infertility. And since I’m no expert on the matter, I got to chat with Dr. Betsy Barbieri, board-certified reproductive endocrinologist at Oregon Reproductive Medicine about the many fertility issues that can affect men and what steps couples should take when looking to start a family. Along with what the heck to say to your man when this difficult subject comes up…

Interview with Betsy Barbieri About Male Infertility

• FBM: What are the steps couples should take when looking to start a family?
• BB: For couples contemplating starting a family, a couple thoughts to bear in mind…the first is age of the couple (especially female partner), as this should influence how long you have time to contemplate versus how fast you jump into action. In general, this is a good time to adopt healthy lifestyle habits to optimize the chance of a healthy pregnancy. Women should begin taking prenatal vitamins to ensure that they have adequate levels of folic acid. Both partners should stop smoking, as this can lead to problems in pregnancy as well as infertility. Additionally, couples should limit their alcohol intake, as there is no safe level of alcohol in pregnancy. If using hormonal contraception (birth control pills, IUD, etc), consider stopping this a few months prior to starting trying to get pregnant. This will give your body a few months to resume regular menstrual cycles. If you do not get regular periods after discontinuation of your contraception, go see your ob-gyn.
• FBM: How long should couples try before seeking help from a medical professional?
• BB: Chances of successfully conceiving are closely related to the female partner’s age. According to the American Society for Reproductive Medicine, infertility is defined by the inability to conceive a successful pregnancy after 12 months of unprotected intercourse. For women 34 and younger, it is recommended to seek help if no pregnancy has occurred after 12 months of trying. For women 35 and older, it is recommended to seek help if no pregnancy has occurred after six months of trying. Additionally, if a younger woman has a history of endometriosis, irregular periods, prior treatment with chemotherapy or prior surgery on her ovaries, it would be helpful to seek help sooner.
• FBM: Should the male and female both be tested?
• BB: As there a many causes of infertility, both the male and female partners should be tested. Etiologies of infertility can be contributed to female issues, male issues or both, and testing both partners will provide the information as to the cause of infertility. Often, by the time a couple has finally decided to seek help with fertility, they are anxious to have answers and eager to move forward. Both partners can be tested during the same month, rather than performing sequential testing of one partner and then the next, to provide information in a timely fashion.
• FBM: Testing can be embarrassing for men. How can they help to minimize this?
• BB: The basic fertility test for men is a semen analysis. This is a microscopic evaluation of their ejaculate, analyzing the quantity, motility and shape of the sperm. Many fertility centers provide sterile specimen cups and allow this collection to be done at home (rather than in the office), provided the sample is brought to the office in an allotted period of time. Some men may feel more comfortable in the privacy of their own home. For men who collect in the office or lab, please remember that this is a professional setting with technicians who process sperm samples multiple times a day. There is no sample so unusual or story so embarrassing that the technicians haven’t heard before. The collection rooms are designated and secluded spots to help men feel more comfortable, where no one can hear you, and with certain “reading material” and “viewing material” provided in case it is needed. Also, the female partner is always welcomed to assist.
• FBM: How can females best help the men in their life going through infertility? What can they say and do? What should they not say or do?
• BB: Infertility can be STRESSFUL. It is hugely important that both partners work together as a team and support each other through this process. Many men take it as a personal affront when there is a problem with their “swimmers.” For female partners, it is paramount to support your partner and reaffirm your feelings for him. Remember, you fell in love with him for who he is, not for his sperm count. Encourage him to adopt healthy habits (if this is not your lifestyle already), and work together with your partner towards concrete but achievable goals, such as weight loss or decreasing alcohol intake. It would NOT be helpful to pester him with reminders of his fertility issues. (“Honey, how many times do I have to remind you not to put your cell phone in pants pocket? Why don’t you use the man purse I bought for you?”)
• FBM: What are some of the lesser known things men can do to help boost fertility?
• BB: Healthy lifestyle habits can help improve fertility. Obesity, smoking, marijuana and anabolic steroids are all associated with impaired sperm function, and have been shown to impact sperm count. Antioxidants, such as vitamin C and E, have be found to produce a slight increase in sperm count and motility. These antioxidants are found in multi-vitamins. Also, a diet rich in fruit and vegetables will help provide anti-oxidants. Environments that may increase scrotal temperature, such as hot tubs, laptops on your lap, may impact sperm, so it would be better to avoid such situations if possible. For men with low sperm counts, “fresher is better.” This means that more frequent ejaculation (every 2 days or so) to produce sperm will provide better results than waiting to “store up” sperm for a semen analysis.
• FBM: What are some of the most common treatments for infertility in men?
• BB: For mild abnormalities in semen analysis (such as a slightly low sperm count or decreased motility), an intrauterine insemination (IUI) is often the treatment of choice. An IUI is a procedure in which the sperm have been washed to concentrate the best, most motile sperm in a small solution, which is placed inside the uterus, when a woman is ovulating. This can improve the sperms’ ability to reach the egg. When significant sperm abnormalities are noted on semen analysis, such as a sperm count of less than 5 million (when normal is greater than 20 million), the male partner would have an evaluation by a urologist to determine if there is an anatomic cause for the sperm abnormalities. A common problem that urologists find is a varicocele (dilated blood vessel in the scrotum), which can be corrected surgically. Additionally, hormonal and or genetic testing may be performed on the male partner to diagnosis the reason for the sperm abnormalities. Some hormonal abnormalities may be treated with medication. Sometime the sperm count is so low that IUI is not an option, and in vitro fertilization (a process in which the female partner takes stimulating medications to develop a number of eggs, which are then removed) with intracytoplasmic sperm injection (identifying a single sperm to place inside the egg for fertilization to occur) would be the treatment of choice. If you have not been successful in trying to get pregnant, do not wait to seek help. No doctor would tell you not to come in for a visit simply because you haven’t been trying long enough…more often, I wish my patients would come in sooner! The first visit to a fertility specialist often includes a discussion about what might be causing the problem and what potential treatment options are. Many patients feel better once armed with knowledge.
• FBM: Anything else you’d like to add?
• BB: Most patients I see are already doing everything correctly, taking prenatal vitamins, timing ovulation with ovulation predictor kits, exercising regularly, etc. and still have not been able to get pregnant. It is extremely frustrating when our bodies fail to perform this natural act month after month. Seek help. There are a variety of treatment options that can assist you in achieving pregnancy. Creating a treatment program with your doctor can help you feel empowered about a process that you may seem out of your control. The journey through infertility may be brief or may prove to be much longer and harder than you anticipated. Whether through exercise, acupuncture or massage, find a good outlet for the stress that infertility often generates. This way, you can remain in treatment for the duration needed to help you achieve a pregnancy.

Thank you so much for the insight and tips Dr. Barbieri! Has your partner been affected with infertility? How did you two best handle it? Any other pointers you can share? —Jenn