THE BLOG
08/04/2015 03:57 pm ET Updated Dec 06, 2017

Infertility Issues: What Men Need to Know

The wish to establish a family is a primal desire; however for 10-15 percent of couples in the United States this may not be possible. An estimated 7.3 million couples are unable to conceive or carry a pregnancy to full term and seek help for infertility issues each year.

If a man has not been able to get a woman pregnant after at least one year of trying without using birth control, they may be suffering from male infertility. It turns out that about 15 percent of couples are infertile. Infertility is defined as the inability to conceive following 12 months of regular intercourse without the use of contraception. This period of time is shortened to six months for women 35 and older, as fertility gradually declines with age. Although, most assume that fertility is a female health problem, 50 percent of couples are actually affected by male factor infertility.

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Male infertility is most commonly due to problems with sperm; either quantity, motility, or size and shape can impacts one's ability to conceive. One of the most common causes of male infertility is a varicocele, which is found in 40 percent of infertile men. A varicocele is a group of dilated veins in the scrotom. For most men they don't cause any issues and thus require no intervention. Some, however, can experience pain or impaired fertility. The dilated vessels increase the temperature of the scrotum, resulting in testicular damage and impaired sperm production. For that reason, when a couple is having difficulty conceiving and all other causes of an abnormal sperm analysis have been ruled out, repair of the varicocele is recommended.

Signs of Male Infertility

• Inability to conceive a child
• Problems with sexual function (difficulty with ejaculation, low libido, erectile dysfunction)
• Pain
• Swelling or lump in one or both testicles
• Recurrent respiratory infections
• Decreased facial or body hair or other signs of hormonal abnormality
• Low sperm count (total sperm count less than 39 million per ejaculate)

As fertility can be impacted by so many variables, every clinical check-up begins with a detailed history and physical exam. Although at times tedious, the questions asked by the physician or urologist help direct the next steps by narrowing the possible diagnoses and subsequent treatments. Semen analysis is a critical step in the work-up of an infertile couple. Semen needs to be collected at least three months following any stressful events or febrile illnesses, as a fever can impair sperm production for up to three months. These samples will be analyzed for several parameters that affect fertility, such as semen volume, sperm concentration, shape and size. The results of this analysis will greatly help narrow the possible causes.

Many chronic conditions can also impact a man's fertility. For instance, diabetes, which affects more than 25 million Americans, can result in abnormal ejaculation. Poor sugar regulation can result in nerve damage including those which are responsible for coordinating ejaculation. Liver cirrhosis can also impact fertility, as the condition is often associated with hormonal imbalances that can interfere with sperm production.

Additionally, drugs and environmental exposures can interfere with viable sperm production. Although it is well known, that drugs like alcohol, marijuana, heroin and cocaine can all impact the quality and quantity of sperm, even some prescription drugs can interfere with normal production. Antibiotics, antacids, antidepressants, gout, and blood pressure medications can also impact fertility. Similarly, exposure to heavy metals, such as lead and mercury, influence its production.

As with most sensitive health issues, myths and rumors are common place regarding male infertility. While some of these have truth behind them, not all are based in reality. For instance, one wives' tale connects long bicycle rides with decreased sperm production; however, there is no conclusive evidence that supports this. On the other hand, another common belief that the use of saunas can reduce fertility is in fact true. Saunas and steam rooms increase body temperature to a level that stifles sperm production. Similarly, keeping your laptop on your lap can decrease sperm production secondary to the heat produced by the computer. It is best to rearrange your workstation or use a laptop fan to keep the area cool. Lastly, although there is an ongoing debate on whether the type of underwear one wears, boxers or briefs, can impact sperm, research has not been able to prove that the type of underwear impacts production.

For men struggling with fertility issues, it's important they discuss concerns with a qualified physician or urologist. This is the only way to ensure your questions will be answered in an accurate manner. Also, when coping with infertility, it is important to approach your concerns with a broad team. You will need to work with many disciplines of medicines including urology, gynecology, and psychiatry and building a team that you trust is key to effective treatment.

Risk Factors for Male Infertility

• Varicocele (most common cause)
• Made up of enlarged veins in scrotum on one or both sides
• Veins make inside of scrotum warmer and can reduce sperm production
• Low sperm production
• Physical problems with testicles (e.g., undescended testicle)
• Blockages in the ducts that carry sperm
• Hormone problems
• History of high fevers or mumps
• Genetic disorders
• Lifestyle or environmental factors
• Smoking, excessive alcohol consumption, abuse of illegal drugs, emotional stress, obesity and age
• Fertility gradually decreases in men older than 35

My 10 Tips for Boosting Male Fertility

1. Visit a Urologist. In order to get your partner pregnant, you must be able to produce healthy sperm, which is produced in the testicles. Sperm then have to be carried into the semen and for this to happen, a sufficient sperm count must exist (higher than 15 million sperm per milliliter). Additionally, a man's sperm must be well-functioning and have good motility. Checking for male infertility is important because it could mean other serious health conditions too, such as a varicocele, infection, hormone imbalance, or testicular cancer. These conditions can often be missed by primary care doctors who will then refer men to a fertility doctor, who may also miss them. Make sure you talk to your doctor about checking for any of the other health conditions so that you can determine what else might be causing male infertility. Your doctor can refer you to an appropriate urologist to learn more about your specific case. If infertility is suspected, there are tests that can be done to confirm fertility problems. Some of the options for treatment include medication, surgery, or assisted reproductive technologies. With treatment, more than 50 percent of cases can be corrected. If semen analysis results are normal, there are natural ways to increase chances of getting a woman pregnant.

2. Try herbs. Studies have shown that some herbs can help increase sperm production such as American ginseng, rosemary, green tea, turmeric, resveratrol, and saw palmetto.

3. Increase the amount of amino acids you get. Amino acids are the building blocks of protein, which are essential for making healthy sperm. L-arginine and L-carnitine may be able to reverse male infertility, but don't take them without the supervision of a doctor. You may also find these amino acids in food sources that contain lots of protein.

4. Avoid smoking cigarettes and marijuana. They increase stress on your body which can damage sperm.

5. Stay well rested to avoid stress. If you are often feeling stressed out and aren't getting enough sleep, the production of healthy sperm can suffer. Find time and ways to relax and make sure you get enough sleep (at least 7-8 hours a night).

6. Eat Brazil nuts, walnuts, and almonds. These nuts are rich in selenium, zinc, and copper which help sperm count.

7. Avoid eating processed food and fast food. They cause inflammation which can affect fertility. Your body doesn't know the difference between when it's eating a whole food or processed food and uses stored nutrients to process what it consumes. When you eat processed food, it takes away the healthy nutrients that could be used to make sperm. Aim to eat more fruits, vegetables, and whole foods with low glycemic index values. Cut down on sugar and salt too.

8. Eat pomegranate. Pomegranate are a natural aromatase inhibitor, which prevents testosterone from being converted into estrogen.

9. Go commando, or at least wear loose undies. Wearing tight underwear can decrease circulation in your testicles which can affect sperm production. Don't wear tight pants either.

10. Be physically active. Being physically active boosts testosterone which helps produce sperm. Make sure to exercise in moderation. Over-exercising can deplete vitamins and stored hormones that are essential to make healthy sperm. Be careful when biking as it can put excessive pressure on the testicles.