Infertility, the failure of a couple to conceive after twelve months of unprotected intercourse, affects approximately 15 percent of couples. With many people unable to get pregnant, a variety of myths have taken root around the topic of making babies. Let’s take a look at several of the most common infertility myths, specifically for men, and the facts behind them.
Infertility is a female issue.
Many people falsely believe infertility is an issue that only impacts women, which leaves women with an undue burden of evaluation and treatment. In reality, men contribute to half of the causes of infertility. Twenty percent of couples are unable to achieve a pregnancy within a year due to male-only related causes, or male factor infertility. Another 30 percent of couples have combined male and female factor causes. When a couple is facing infertility, both partners should seek evaluation to identify and treat reversible causes.
Male infertility is irreversible.
The purpose of the male and female fertility evaluations is to diagnose and treat reversible causes. The male work-up generally includes a comprehensive history and physical exam, semen analyses, and laboratory tests. Hormonal abnormalities can be identified with tests and corrected with medications that can improve sperm count as well as erectile and ejaculatory function in some cases. Varicoceles, or dilated veins in the scrotum, are the most common cause of secondary male infertility, or infertility in men who have had previous children. Varicoceles, which require a physical exam for diagnosis, are identified in 15 percent of all men and in 40 percent of men with infertility. Therefore, not all varicoceles affect fertility, but those that do can cause a progressive decline in semen parameters over time. Varicoceles can be repaired surgically in order to improve sperm count or prevent further decline.
Testosterone is a treatment for male infertility.
A man’s natural testosterone production is essential for sperm production. Recently, there has been increasing awareness about low testosterone or hypogonadism. Testosterone replacement therapy as a treatment for low testosterone can impair sperm production and has even been studied as a male contraceptive. When men are treated with testosterone, their brain senses there is sufficient testosterone available and stops stimulating production. Intratesticular testosterone levels decline and sperm production is inhibited. Testosterone replacement therapy should be avoided in men attempting to conceive. There are alternative treatments for hypogonadism that stimulate a man’s testosterone and potentially improve sperm production.
Sperm become depleted with frequent intercourse.
Timing is everything. For women, there is approximately a 6-day fertile window that ends on the day of ovulation. Men with normal semen parameters are able to maintain the normal levels of sperm with daily ejaculation. Men with low sperm concentration and motility may improve with daily ejaculation. Prolonged abstinence of greater than five to ten days may diminish sperm count. Intercourse occurring daily or every other day during the fertile window has the highest pregnancy rates per cycle, 37 and 33 percent respectively.