Healthy Manhattan: When Men Are Infertile

Written by Dr. Cynthia Paulis on . Posted in Healthy Manhattan, Posts.

Imagine spending your twenties playing the field and being careful not to get anyone pregnant. Now you meet the girl of your dreams, marry and want to start a family at 35, but you can’t—and the problem is not with your wife, it’s you. That’s what happened to Mike.

"I was surprised and unsure of what it meant," said Mike, an attorney who spoke on the condition that his last name not be revealed. He and his wife Susan (not her real name) had been trying to have a child for a year, and they had assumed Susan was the one with the fertility issues. She had two rounds of in vitro fertilization, which were unsuccessful. Finally they looked at Mike. He had a chromosomal abnormality, which caused low motility of his sperm.

Male infertility is not as easy to recognize as female infertility. For a male to get his partner pregnant, he must produce healthy sperm that can reach, penetrate and fertilize the egg, but several other factors are involved. The sperm must be healthy, which requires functioning testicles, and there must be enough hormones to maintain sperm production. The sperm has to be carried into the semen and there needs to be enough sperm in the semen to increase the odds of fertilization. The sperm must be shaped correctly and be able to move for penetration of the egg. If one of these factors is off, fertilization won’t take place.

There are often medical causes that interfere with fertility issues. Infections such as sexually transmitted diseases can interfere with sperm production, as can inflamed testicles from mumps or prostatitis. A varicocele, which is a swelling of the veins that drain the testicle, can prevent cooling of the testicle and lead to low sperm count. Retrograde ejaculation, where the semen enters the bladder during orgasm instead of the tip of the penis, is another problem. Other sperm problems can be caused by diabetes, multiple sclerosis, spinal injuries and certain medications such as Flomax, Hytrin and Uroxatral. Tumors, undescended testicle, hormone imbalances and chromosomal defects can also create sperm issues.

There are also environmental issues, such as heat, toxins and chemicals that will reduce sperm count. Frequent use of sauna or hot tubs will lower sperm count, along with sitting for prolonged periods or wearing tight clothing. Prolonged bicycling can overheat the testicles and also put pressure on the area behind the testicles, causing erectile dysfunction.

Other causes of male infertility are drugs such as anabolic steroids, cocaine and marijuana, which can reduce the number and quality of the sperm. Heavy drinking and tobacco smoking have also affected sperm. Vitamin deficiencies in C, selenium, zinc and folate have also been implicated, as well as being overand underweight. Sometimes the use of lubricants such as Astroglide or K-Y jelly has been known to reduce sperm movement. Just as women have a decline in fertility over the age of 35, men have the same issues.

In Mike’s case, he had testicular surgery where semen was extracted and then injected into the egg, which produced a daughter. When he first saw her he was "speechless." Mike and Susan wanted another child, so three years later they went through the process again, and he learned they were having twins. "I was in shock and disbelief," he said. "You know it’s always possible, but when it happens you can’t fully comprehend it." He said the first couple of years of parenting were rough, but "it’s a game changer once they start communicating with you."

Mike put the "jaw-dropping" costs at $120,000, factoring in labs, medicine, IVF and trips to the city from Long Island.

Mike’s advice to couples going through infertility issues is to know when you want to stop. It is now five years since he went through the process. "When it’s happening, you don’t know, and if not, then you make the decision to adopt or not."

When asked what’s the best part of being a parent, Mike said, "Father’s Day. It’s the best holiday of the year. Your kids look up to you, they come as a clean canvas and it’s up to you to fill it up. They come with their handmade cards and genuine emotion, so pure, so simple. It’s priceless."