Male Fertility Evaluation

Male Fertility Assessment

It’s estimated that up to one-third of all fertility complications suffered by couples is related to a male factor.  A simple way to categorize male fertility barriers is to divide problems into obstructive and non-obstructive problems. Obstructive problems indicate a blockage somewhere in the male reproductive tract from the testicle all the way into the urethra.  Most obstructions can be surgically repaired.  Non-obstructive problems indicate an impairment in sperm production.

The UCLA Men’s Clinic evaluates male fertility with

• thorough medical history
• physical exam
• semen analysis
• bloodwork
• ultrasound and radiologic examination, only if needed.

A semen analysis looks for:

• Azoospermia, where no sperm are produced or sperm do not appear in the semen.
• Oligospermia, where few sperm are produced.
• Problems with sperm motility, which reduce the likelihood of fertilizing an egg.
• Problems with sperm form and structure (morphology).

Two normal semen analyses are typically required to rule out significant infertility problems.

Hormonal imbalances in men can also affect a man’s fertility.  Testosterone is critical to improving sperm function and production.  Low testosterone levels therefore can negatively impact sperm production and be a sign of overall poor health.

Explaining Male Factor Infertility

Jun 07, 2017 - Dr. Jesse Mills, clinical professor of urology and director of The Men’s Clinic at UCLA, explained male factor infertility June 7 on the Huffington Post’s “IVFML: A Podcast About Infertility,” a miniseries in which senior editor Anna Almendrala and her husband, Simon Ganz, discuss infertility, miscarriage and IVF as they share the story of their journey toward parenthood. Mills is featured in Episode 4: The Blame Game.

Chinese Medical Journal

Male infertility: lifestyle factors and holistic, complementary and alternative therapies.
David F Yao, Jesse N Mills. View Complete Journal.

What causes male infertility?

• Sexually transmitted diseases or other infections.
• Blockages, birth defects or physical damage. Some men are actually born with blockages in parts of the reproductive tract or other abnormalities that prevent sperm from getting into the semen. Physical trauma to the testicles, prostate, and urethra can also result in fertility issues.
• Retrograde ejaculation, a disorder in which semen doesn't come out of the penis during ejaculation and instead enters the bladder. It can be caused by diabetes, some medications and surgery to the bladder, prostate or urethra.
• Genetic diseases. Abnormalities in the normal male chromosomal structure, including gene deletions in the Y chromosome, genetic abnormalities in the pituitary gland and Cystic Fibrosis gene mutations can all contribute to male fertility problems and can be assessed at the UCLA Men’s Clinic.
• Autoimmune disorders where a man’s immune system mistakenly targets and damages sperm cells.
• Hormonal problems. Certain hormonal imbalances such as those occurring in the pituitary and thyroid glands can cause infertility.
• Erectile dysfunction and premature ejaculation. Learn more about the erectile dysfunction treatment options at The Men's Clinic at UCLA. (link once this content is added)
• Varicoceles. Venous blood flow from the testicle flows back through a series of veins that ultimately travel back to the heart.  When these veins become enlarged, usually through heavy weight bearing exercise, prolonged time on one’s feet or just from being tall, the valves that normally push blood upwards, against gravity, and back to the heart stop functioning properly and the blood pools around the testicles.  Testicles and sperm like to be 2 degrees Fahrenheit cooler than the rest of the body.  If the testicles are constantly surrounded by heat from these varicose veins, their function is impaired.
• Heat, alcohol, drugs, food and stress as well as exposure to environmental toxins also impact a man’s fertility.

If, following irregular semen analyses, you’ve been diagnosed with infertility, your UCLA physician will first discuss potential lifestyle changes that could improve your chances of conceiving. Weight loss, a protein-rich, low sugar, high fruit and vegetable diet and sensible exercise program are all good ways for a man to improve his own fertility.  Your UCLA Men’s Clinic physician can provide you with tips to be successful in lifestyle modification.

If a man’s reproductive hormones are abnormal, he may be a candidate for hormonal therapies that can improve fertility chances and often improve overall health.

If a man has non-obstructive azoospermia, he may still have sperm in very small quantities in the testicle.  He therefore may be a candidate for a microsurgical testicular sperm extraction (Micro-TESE). (link once this content is added) This is a highly technical procedure only a handful of microsurgeons perform nationally.  At The Men's Clinic at UCLA, our physicians are highly skilled in this procedure and can maximize the chances of successful sperm retrieval and pregnancy.

Scheduling an Appointment

Board-certified urologists staff The Men’s Clinic at UCLA and you can be assured you are getting an experienced physician performing your evaluation in a relaxed and comfortable environment. For more information and to schedule an appointment, please call the UCLA Urology Appointment line at 310-794-7700.