Philip Werthman, FACS (Director, Center for Male Reproductive Medicine) gives expert video advice on: What causes infertility in men? and more...
How common is male infertility?
Male infertility is actually quite common. Of all the people trying to conceive that have been unable to do so, approximatley 40% of the cases are responsible in some way to the man. One out of every 8-10 couples experiences difficulties trying to conceive, so if half of those cases are related to the man, then you're talking to 5-10% of the male population may have trouble conceiving with his wife, which is exceptionally common.
What causes infertility in men?
There's a large number of causes or reasons for a man to experience fertility problems. One of the most common things is something called a varicocele, which are varicose veins around the testicle. Other issues could be obstruction or blockages in the reproductive tract. There could be hormonal issues. It could be issues with age such as the <a href="http://www.videojug.com/interview/andropause-male-menopause-2">male menopause</a>, it could be issues with environmental toxin exposure, with heat exposure, with chemicals, with drugs, with prior surgeries. There are a numerous variety of things that can cause damage to the sperm. We are still learning every day about all the different things that can cause fertility problems for men.
What causes blockage of sperm?
There are numerous things that can cause blockage of sperm or blockage of the reproductive track. You can be born with a blockage, a condition called congenital absence of the vas deferens, meaning being born without the spermduct or tube called a “vas,” that a doctor cuts when he performs a vasectomy. The testicles make sperm as normal but the sperm can't be released because there is no tube or no "plumbing" so to speak. Another issue that can cause blockage of the sperm tube is a vasectomy; which is designed to cause a blockage so that a man can't impregnate a woman. He might later change his mind and decide he wants to conceive again. There are issues such as infection, chlamydia and gonorrhea for example, that can cause blockages to the reproductive tract. There can be cysts or disorders of the prostate that also can cause blockages for sperm, so there are numerous things that may cause an obstruction.
What is "varicocele"?
A varicocele is very simple. It is varicose veins around the testicle. Just as many people as they get older get varicose veins around their legs, many can get varicose veins around the testicle. They are normally a series of several veins that take the blood from the testicle and return it to the body. These veins have one way valves in them so that when you sit up or stand up the blood does not run down with gravity toward the lowest area of the body.If these one way valves don't work then what you have essentially is a vein that is supposed to be a one way street that becomes a two way street. The blood then is allowed to pool around the testicle and can cause damage to the testicle and damage to the sperm production.
How is varicocele treated?
Vericocele is usually treated with surgery. It's a very tiny surgery, outpatient, where a doctor can go in microsurgically and block the veins, stop the abnormal flow of blood back down to the testicle. There are also a variety of other treatments. This can be done laparoscopically. It can also be done radiologically, through a procedure called embolization, where a doctor would go in with a little catheter through one of the big veins in the leg, and snake this catheter into the vein of the testicle and then block the vein from the inside. As opposed to doing it surgically, where you block it from the outside by putting a tie around it, here you put little balloons or coils in that cause the vein to clot off and stop the abnormal blood flow. What's been clear over the last few years is the best way to do this is microsurgically, because it offers the best results, the best chances of success, with the least amount of complications.
What is "oligospermia"?
Oligospermia is a term we use to describe low sperm count. So the World Health Organization came up with parameters for semen analysis that they call normal and it's a big range. For men, the range is anywhere from 2 million sperm per cc, up to over 12 million sperm per cc. So you can see that's a very large range. Any time the sperm count is consistently under 2 million we call that Oligospermia.
What is "azoospermia"?
PhAzoospermia is the term we use to describe the condition where there is no sperm present in the semen and this can be for a variety of different reasons. Number one, someone could be making sperm normally in his testicles but has a blockage so the sperm can't get out into the semen or number two, there can be a problem with sperm production in the testicles such that the man is making no sperm whatoever or very, very small amounts of sperm so small in fact that you don't see any sperm in the semen even though they are present in the testicle. The good thing about azoospermia is that the majority of men can now become fathers through in vitro fertilization or through correction of blockages whereas ten or fifteen years ago this was an impossibility. So reproductive technology has advanced so much in the last ten years that very few men can no longer be genetic fathers.