The Importance of the male infertility evaluation


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Male infertility issues are very common. Each year, approximately seven million couples in the United States experience difficulty establishing a pregnancy. You might not realize it, but odds are you have friends, family, or coworkers who have struggled with infertility. This is because infertility is one of a handful of “silent” medical problems that couples often keep to themselves. This silence is especially common when fertility problems affect the male partner.  Men may experience feelings of embarrassment or shame, especially if they do not know any other men with these same issues. In fact, however, male factor problems are present in fully 50-60 percent of couples who are having trouble conceiving,  which means that three and a half million men are experiencing these issues just in the United States. This number of men could fill Ohio State University’s football stadium to capacity thirty-five times over!

The good news is that the majority of male fertility problems are treatable if they are identified and managed effectively. So why is it that the vast majority of men in couples with infertility issues still do not undergo any evaluation, and even fewer receive effective treatment for their problems?

Several factors play a role:

1. Most of the information available on fertility websites focus on female issues, and most people (as well as health care professionals) do not realize that male factor problems impact half of all infertile couples.

2. Young, healthy men often do not seek evaluations from health professionals.

3. Some women are given the false impression that if they work with a specialist in female infertility and pursue treatments from the female side (such as intrauterine inseminations or in vitro fertilization) that the male factor really does not make a difference.



For the majority of couples, the female partner is usually the starting point in pursuing fertility evaluations and treatment. Great advances have been made in the treatment of female fertility issues over the last twenty years, with the advent of better medications, surgeries, and techniques. In the meantime, the field of male infertility has lingered on the margins with little attention from either medical professionals or the popular media.

The fact is that the male contribution to fertility (for example, sperm quality) has a huge impact on a couple’s chances of conceiving and delivering a healthy child. Unfortunately, this very important point seems to have been lost over the past twenty years, during which time the medical field has increased its focus on female health and fertility. An exclusively female-focused approach to fertility management may miss the fact that optimizing the male’s fertility potential can improve a couple’s chances of conceiving naturally, as well as increase the success rates of interventions from the female side such as intrauterine insemination (IUI) and in vitro fertilization (IVF), including even if intracytoplasmic sperm injection (ICSI) is utilized.  In addition to improving pregnancy rates, the evaluation and management of male fertility problems also has the potential to increase the chances of having a child who is healthy and has a lower risk of genetic abnormalities.

Another very important reason to evaluate all men in couples with infertility is that men with an abnormal semen analysis are at an increased risk for certain potentially serious health problems, such as testicular cancer, pituitary tumors, and hormonal imbalances. Often these medical problems have no early symptoms other than a decrease in male fertility. If the male partner in couples with fertility problems is not evaluated, these medical problems might remain undetected until they reach more advanced stages.



If a couple wants to truly maximize their chances of reproductive success, it is very important that they be proactive and take control of their own fertility treatment process. But getting accurate, updated, and trustworthy medical advice on male fertility problems can be much more difficult than finding someone to manage your blood pressure or broken wrist. This is because most physicians receive little to no training in managing male fertility problems, even within the field of urology itself.


Unless you are working with a trained specialist in male infertility, I would recommend approaching medical advice about male infertility with a healthy dose of skepticism, for a few reasons:


1. Doctors often underestimate the impact of male factor problems on infertility

Most health care providers, including primary care physicians and ob-gyns, do not realize how common and potentially treatable male fertility problems are. Therefore they are not going to recommend a basic male evaluation, such as a semen analysis, nearly as often as they should. If it happens that problems are discovered (the results of a semen analysis test come back abnormal, for example), patients are often inappropriately referred to either a specialist in female fertility or a general urologist rather than a specialist in male infertility.


2. It is hard to find a qualified male fertility expert

The number of physicians who know how to effectively treat male infertility problems is very limited. Primary care physicians almost as a rule do not know how to manage male fertility problems, simply because it is beyond their scope of practice and training. Specialists in female fertility (reproductive endocrinologists) don’t receive training to manage male fertility issues. Urologists are usually assumed to be the experts in male reproductive health, but the truth is that most general urologists receive little to no in-depth training in managing male fertility problems.

Experts in male fertility can be found.  A small number of urologists choose to devote extra time to complete the advanced fellowship training that is necessary to become an expert in managing men with fertility problems.  They sometime also work alongside specially trained mid-level providers (nurse practitioners and physician assistants) that manage the basic male fertility evaluations and problems.  I strongly recommend that you seek out medical care providers who are specially trained in managing male fertility issues to work with in order to receive the most thorough and best-informed care possible. Unfortunately, I have seen many couples lose valuable time to incomplete and ineffective management of their male fertility problems when they did not start out with the proper specialist. It is worth the extra effort it might take you to find a medical care provider providing specialty male infertility care.  If you unfortunately do not have a male fertility expert in your area, the information on this website can help you make sure that you are receiving quality fertility care by preparing you with appropriate questions for the non-specialist provider with whom you are working.


3. Specialists in female fertility are not trained to focus on male factor infertility

Reproductive endocrinologists (REs) are experts in female fertility, and as such, they may tend to overlook male factor issues even though male fertility issues impact at least 50 percent of their couples.  In my practice, I am very fortunate to work with REs who generally recognize the importance of evaluating and treating male partners.  However, this good working relationship seems to be more the exception than the norm. In many cities, only men who have absolutely no sperm to work with are referred for a male infertility evaluation—leaving all the other male fertility issues largely overlooked. Why does this happen? To be sure, the biggest issue is lack of awareness. However, in some areas the problem may result from a basic conflict of interest: couples who require a higher level of treatment from the female side generate more revenue for the RE practice. When the male partner’s problems are addressed by a male fertility expert and his semen parameters improve, the couple may not need as advanced a treatment from the female side (for example, they may now be candidates for IUI, and not need the more expensive IVF). RE groups therefore may have an economic incentive not to refer the male partners in their couples for evaluation. Thankfully, this is usually not the case, as the vast majority of REs I know work in the best interest of their patients. However, if your RE is downplaying the need for a male infertility referral without offering a good reason, it could be a sign that you need to be proactive and ask more questions.  



Don’t be afraid to take charge of your fertility care—remember that you are your own strongest advocate! Make sure that a semen analysis is performed prior to starting any female fertility treatments, and if abnormalities are found, then take the steps necessary to improve the male factor potential as much as possible. Using the best-quality sperm is going to provide you with the best chance of successfully conceiving and delivering a healthy baby.


If a couple truly wants to maximize their chances of conceiving a child, they should not overlook the importance of identifying and treating male fertility issues.  The goal of this website is to serve as a resource for couples seeking accurate and updated information regarding male infertility diagnosis and management. Male fertility problems are extremely common, relatively easy to diagnose, and often treatable. It’s time to bring these issues out of the shadows and give them the attention they need in order to help more couples achieve successful pregnancies.  The purpose of this website is to provide information to help you to achieve your fertility goals- we hope you make the most of it and find our site to be helpful.