Understanding Male Infertility: Breaking the Misconceptions

In this video, board-certified urologist Dr. Veruca discusses the importance of considering male factors in infertility. He emphasizes the misconception that infertility issues are solely the wife’s problem and highlights that about half of couples dealing with infertility have a male factor component. He encourages men to seek medical help without feeling less virile or masculine. Dr. Veruca explains that various factors can contribute to male infertility, including medication use, age, drug use, smoking, and anatomical issues. He discusses the diagnostic process, treatments available for couples, and alternative options like intrauterine insemination (IUI) and in vitro fertilization (IVF) provided by fertility specialists.

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Key Insights:

  • Historically, infertility was often seen as the wife’s problem, but there is now an understanding that male factor infertility plays a significant role.
  • Many men feel hesitant to seek help, but infertility is a medical condition and does not reflect their masculinity.
  • Possible causes of male infertility include medications, age, drug use, smoking, anatomical issues, and varicocele.
  • Diagnosis involves a questionnaire, physical examination, semen analysis, blood work, and sometimes ultrasounds.
  • The most common issue is sub-optimal sperm production, while a zero sperm count can be caused by missing ducts, genetic disorders, cancer treatment, or infections.
  • Treatment options vary depending on the cause and may include hormonal medications, surgery to correct varicoceles, or procedures to extract sperm directly from the testicles.
  • Success rates for improving sperm production range from 50-70%, with varicocele correction and hormonal management showing higher success rates.
  • For cases where male factor infertility cannot be resolved, fertility specialists may offer treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) to bypass the issue and increase the chances of pregnancy.


Hello everyone, I am Renatha, and this is board-certified urologist Dr. Veruca. He helps couples trying to get pregnant, from couples that want to take a pass on it.

What do they need to know when it comes to the male side of things? Historically, if we looked at couples who were dealing with infertility, everybody would always look at the wife and say that this is the wife’s problem, and the woman is the issue. And that is very far from the truth. One of the things that we’ve learned is that if half of couples who are dealing with this issue, there is a male factor component. And so our objective is to break this misconception that men are also playing a role in this, and we need to be looking at it.

Do you often see couples together, or is it usually just the man who comes to see you?

And have they already seen fertility specialists by that point? They’ve usually been seen by the female partners‘ doctors. Very often, the male partner will come in alone. When the male partner does come in with the female partner, you have kind of the sheepish guy who’s kind of sitting with his head down, and they feel kind of less virile and less macho. And they don’t need to feel like that. This is a medical condition. This has nothing to do with them being a man. Men should be comfortable. You know, we’re here, we’re here to help.

But when it comes to male infertility, what can be the causes?

There are a few different things that can cause it. In some people, it could be related to some of the medications that they may take. They could be age-related. Certainly, people who are using drugs, you know, marijuana, certain other drugs can cause it. Smoking can cause this. There are anatomical issues that can cause it. There’s a wide variety of things, and it’s really our job to figure this out.

So, how do you go about making a diagnosis? As a patient comes in, usually, we’ll do a questionnaire. We’ll speak to them very in-depth. We’ll do a long physical examination on them, and then we’ll have them give us a semen analysis. We’ll do some blood work, and then some people will do some ultrasounds to kind of take a look. And within that, that then leads us to help make a diagnosis.

The more common group are men who have sub-optimal sperm production. So, they may either have an imperfect sperm count or the sperm not swimming the way they should or we may not get perfectly normal sperm shapes. Very often, it could be patients who are using anabolic steroids or using testosterone in the gym. We can find people who are, you know, their diets may be off. It could be the anatomic abnormalities. The most common is something called the varicocele, which is a swelling in the veins that return the blood back from the testicle. It’s a very common finding. It’s seen in one in eight men. There’s nothing unusual, there’s nothing abnormal about having it, but in the people who do have it, sometimes that can affect their sperm production.

The other group that we’ll see are patients who have a zero sperm count, which is obviously a much more severe presentation. In terms of the things that can then lead to that zero count, in some men, they’re born missing some of the ducts that are needed to carry the sperm out. So what’s happening is the sperm is being produced within the testicle, it gets to the loading dock, but there’s no truck to carry the shipment. The others can very often be genetic disorders that patients will have, which those men will lead completely normal, long, full lives and never understand that they were either missing a gene or they had an additional chromosome or something else that’s contributing to that, and then they will then present with a zero sperm count. Unfortunately, in some men who’ve had either childhood cancers or cancers at a young age, that can also affect their sperm production, and we can find certain infections that can lead to a zero sperm count. But we always say to men, if you’re coming in and you have a zero sperm count, the deal is not done. We still have many different things that we can do.

What kind of treatments are available for couples who are struggling?

It’ll depend on what abnormality we find. Very often, if there’s a hormonal issue, then we can give medications that can support the hormone production. You know, the other things that we look at are, are there things that we can surgically correct, which includes surgery to fix varicoceles. In some men, it includes surgery to go into the testicle itself to try to find sperm production.

Alright, so for folks full in conceiving after receiving treatment?

So, in most couples, if I had to give you a ballpark estimate, it’s around 50 to 70 percent we can help with their sperm production. Usually, it’s going to be those men where we’re finding a varicocele that’s playing a role, or in men where there’s a significant hormonal imbalance that we can manage that can be very clearly corrected. Unfortunately, in the other groups, usually what we’re seeing is that it’s a very subtle abnormality, and so we’re more limited in terms of our toolbox of things that we can do that can help. But there are other treatment options out there that can bypass us treating the male factor, so these are usually done by the female fertility specialist. The primary ones that we think about, number one, is intrauterine insemination, which is called IUI. Essentially what happens, the male partner will make a sample, they’ll wash that sample, take the best swimmers, and then inject that directly into the female partner’s cervix, so it’s bypassing the first barrier in terms of pregnancy. Depending on the female partner’s age and general health, in general, it’s around a 20% likelihood of success per attempt, which is actually fairly reasonable. The other thing that we think about is things like in vitro fertilization, which is called IVF. Essentially what’s happening in that scenario is the man makes a sample, the woman is stimulated to make extra eggs, and then those eggs are taken out from her body through a very simple minor procedure, and the sperm is then used to fertilize the egg. The nice thing in that scenario is we don’t need the usual millions of sperm. Modern medicine has led to many different miracles, and it’s quite exciting. You know yourself that did some work on this, alright? Board certified.