The Male Factor: What Couples Need to Know About Fertility
When couples struggle to conceive, it’s often the woman who undergoes the first round of testing. But fertility isn’t just a women’s health issue. Male factors contribute to about half of all infertility cases, either on their own or alongside female factors — a reality that surprises many people going through the process for the first time.
The encouraging news is that many causes of male infertility can be identified through straightforward testing, and some are treatable. Knowing where to start can make the process feel far less overwhelming.
According to Dr. Joseph Dall’Era, urologist with Colorado Mountain Medical, male-factor infertility plays a role in roughly 50% of infertile couples.
“The biggest misconception is that infertility is primarily a women’s issue,” he says. “Both partners should be evaluated early in the process.”
Male infertility most often comes down to issues with sperm count, movement or shape. The reasons behind those problems can vary and may include hormonal imbalances, genetic conditions, anatomical issues or lifestyle factors.
One of the most common treatable conditions is a varicocele, an enlargement of the veins around the testicle. Because these veins interfere with the testicle’s ability to regulate temperature, they can reduce sperm production and motility. Previous surgery or trauma can also create blockages that prevent sperm from traveling normally.
The First Step
For most men, fertility testing starts with a semen analysis. It’s a simple test, but it provides valuable information about sperm count, motility, which measures how well sperm swim, and morphology, which looks at their size and shape.
Dr. Dall’Era recommends completing a semen analysis early in the fertility workup instead of waiting until other testing has already been done.
If the results suggest a problem, additional testing may include hormone evaluation, imaging or genetic testing to help pinpoint the cause.
Many couples begin with a fertility clinic, where both partners are typically evaluated at the same time. In some cases, the female partner’s fertility specialist orders the semen analysis or refers the male partner to a urologist. But men don’t have to wait for a referral.
A primary care provider can help determine whether additional evaluation is needed, while a urologist specializes in diagnosing and treating male fertility concerns. Depending on the findings, treatment may focus on correcting an underlying medical condition, addressing hormone imbalances or improving sperm health.
Lifestyle Changes
Not every cause of infertility can be prevented, but certain lifestyle habits can have a meaningful impact on sperm health.
Dr. Dall’Era says obesity is one of the most commonly overlooked factors because it can disrupt hormone levels, including increasing estrogen production, which may interfere with sperm production.
Other factors that may negatively affect fertility include:
- Recreational drug use, including marijuana
- Excessive alcohol consumption
- Frequent exposure to high heat, such as regular hot tub or sauna use
Another important consideration is testosterone replacement therapy. Many men don’t realize that taking testosterone from an outside source can shut down the body’s natural sperm production. Fertility often returns after treatment is stopped, but recovery can take time and isn’t guaranteed. Men who hope to have children should discuss those plans with their healthcare provider before starting testosterone therapy.
Finding Answers
Today’s fertility evaluations are more comprehensive than ever. Locally, Colorado Mountain Medical offers access to semen analysis referrals, hormone testing, genetic testing when appropriate and evaluation for treatable conditions such as varicoceles and hormone imbalances.
For couples trying to grow their family, evaluating both partners from the beginning can lead to answers sooner and help identify treatment options that improve the chances of conception.
“Male fertility is an important piece of the puzzle,” Dr. Dall’Era says. “The earlier we evaluate both partners, the sooner we can identify the cause and discuss the best options moving forward.”
