Ask A Urologist: Dr. Solomon Hayon, M.D. Answers Your Questions About Male Fertility

Male fertility is often overlooked when talking about reproductive issues. We asked Dr. Solomon Hayon, a reproductive urologist and men's health expert at MUSC Health, to answer some frequently asked questions about how to improve your chances of getting pregnant, who's at higher risk for fertility issues and more.

How Common is Male Infertility?

Infertility is much more common than you think. About 15 percent of couples struggle with fertility issues. About 30 percent of the time, of those couples, the primary issue is actually on the male side. Another 20 percent of the time, male factor infertility is partially contributing to what's going on. That's why it's so important for both men and women to be evaluated when we're talking about fertility issues.

How Can a Man Improve His Fertility?

We can sometimes use medications and even surgery to help improve male fertility. Otherwise, a generally healthy lifestyle is super important for sperm production. There's no magic supplement or vitamin that will improve your fertility. But we do know that male infertility is associated with things like viral illness, obesity, poor diet, tobacco use and marijuana use. There's also certain medications to avoid, like testosterone, which can impair your fertility.

How Does A Man Know If He is Fertile?

I get this question all the time from guys. The first and most important step in answering that question is to get a semen analysis or sperm test. From there, the next step would be a trip to the reproductive neurologist, where you get an exam, a detailed history and potentially hormone and genetic testing.

How Many Sperm Does It Take To Get Pregnant?

Assuming there's no issues on the female side, we use the total number of moving sperm to help determine what might be the best method to try and conceive. For men with more than 20 million moving sperm, we recommend natural conception. For men with less than (20 million moving sperm), they may need assisted reproduction to try and help them conceive. That would involve things like intrauterine insemination, or for even lower counts, IVF or intracytoplasmic sperm injection (ICSI), which is when an embryologist takes the sperm and the egg, and puts them together outside the body.

What Are Fertility Options After a Vasectomy?

After a vasectomy, you still make sperm, and there are two main ways to try and achieve a pregnancy. The first is through a sperm extraction, where sperm is taken directly from the testicle or epididymis and then combined with an egg during IVF.

The other is a vasectomy reversal, where the two very tiny tubes are reconnected using an operating microscope. Both these procedures take special training and special equipment. It's important to talk to your reproductive neurologist. about which one would be best for you.

What Is a Varicocele?

A varicocele is dilated testicular veins, kind of like a varicose vein in the scrotum. They're super common and found in about 15 percent of men. But, for men with fertility issues, varicoceles can be present up to 40 percent of the time. Depending on how severe the varicocele is, fixing it with a procedure or surgery can help improve sperm count about 50 to 60 percent of the time.

How Can You Increase Your Chances of Getting Pregnant?

The first thing men should do is get evaluated. That way, you can make sure you're doing everything you can to optimize both your sperm count and your sperm quality. After that, getting pregnant is all about timing. There's only about a six-day window each month called "the fertile window", where the sperm and the egg can meet at the right time. During this fertile window, we recommend couples have intercourse every day or every other day to try and maximize their chances.

Why Is Male Infertility Overlooked?

Assisted reproduction technologies have gotten so good, with IVF and ICSI in particular, that you actually only need one sperm to inject directly into the egg. So when couples and doctors get focused on trying to achieve a pregnancy, sometimes the male can get bypassed and overlooked in that process.

Who Is Most At Risk For Male Infertility?

Infertility can happen to anybody, but there are certain populations that have a higher risk of fertility issues. Those can be people with genetic problems such as klinefelter syndrome, which is when a man is born with an extra copy of the X chromosome, or cystic fibrosis. Those who have exposure history to medications like testosterone or chemotherapy can also be at a higher risk.

We also see higher risk in those with other comorbidities like diabetes, which can cause problems with ejaculatory function. Anatomic issues like a varicocele can also cause issues with sperm production, as well as a prior surgery that caused a blockage of the vas deferens in the sperm tube. A great first step is to get a semen analysis and potentially be seen by a reproductive neurologist.

When Does Male Infertility Begin and How Long Does It Last?

The timeline of male infertility is different for everyone. You can have primary infertility, which is trouble conceiving the first time you try to conceive. You can have secondary infertility, where you could conceive before, but now due to a change like an ongoing varicocele or chemotherapy exposure and you're now having trouble conceiving. It's important to remember that the timeline of semen production is about three months. Any changes that you make now won't show up in a semen analysis until about three months later.

What Conditions are Associated with Male Infertility?

For men with very low, or even absent sperm counts, there are three main genetic things we look for: The first is Klinefelter syndrome. The next is a Y chromosome microdeletion, where men can be missing a small part of the Y or male chromosome. And the third is cystic fibrosis, which usually doesn't lead to a problem with sperm production, but can lead to an issue with sperm transport. A reproductive neurologist can order those blood tests and help you determine the next step.

The most important thing to remember about male fertility is that there are often interventions, medications or surgeries that can help you on the way to achieve a pregnancy. Beyond that, a trip to the reproductive neurologist can be a great first step at evaluating your overall health. Up to about six percent of men with infertility issues have an undiagnosed underlying medical issue. Anything that you do will be a great first step in trying to optimize both your health and the health of your future offspring.

Learn more about urology care at MUSC Health, or make an appointment with Urologist Dr. Solomon Hayon.