Male Fertility

Though a vasectomy was formerly considered a permanent sterilization procedure, modern developments have made reversal possible. This article will outline the various procedures for reversing a vasectomy and the likelihood of success in restoring fertility, including a comparison to alternative fertility options.

This article focuses on sperm retrieval procedures, which are procedures that remove sperm from the testicles for the purpose of fertilizing an oocyte (egg). This may be used for men with no sperm in the ejaculate (azoospermia), but that still produce sperm in the testes.

There are two main types of techniques for surgical sperm retrieval: aspiration and extraction. Sperm aspiration involves using a needle to remove (aspirate) sperm from the epididymis or the testes. Sperm extraction takes a sample of the tissue, known as a biopsy, to collect the sperm. There are also different variations or subtypes of these procedures, as well as non-surgical approaches for those with ejaculation limitations.

Klinefelter syndrome (KS) is a genetic condition whereby a male is born with an extra X chromosome. This condition often impacts fertility in addition to potentially other areas related to health and development, though having this condition does not necessarily mean a person cannot have biological children. By understanding this condition's symptoms, causes, risks, and treatments, those with KS can navigate treatment options.

Infertility is recognized as a disease by the World Health Organization (WHO), as well as many other professional societies, including the American Medical Association (AMA), the American Society for Reproductive Medicine (ASRM), and the European Society of Human Reproduction and Embryology (ESHRE).^i,ii,iii,iv Estimates of infertility frequency vary worldwide, and even differ depending on the way data is collected. Prevalence is the term used to describe how common a disease/condition is in a particular population. According to the US National Survey of Family Growth, approximately 19.4 percent of married heterosexual women aged 15-49 years have experienced infertility.^v Estimates in the UK population for a similar population were 12.5 percent.^vi Some studies indicate that the prevalence of male infertility is approximately 10-15 percent, but these estimates may not be accurate due to the lack of good quality evidence.^vii

Sperm donation is a process in which a fertile male donates semen (ejaculatory fluid containing sperm) that can be used by an individual or couple wanting to have a baby. An understanding of how sperm donation works, what its success rates are, and why people might opt to use sperm donation are helpful in determining what that type of fertility journey might look like.

Approximately 20 to 30 percent of infertility cases are due solely to male infertility, and male infertility contributes to about half of infertility cases overall.ⁱ Sperm defects are a leading cause of male factor infertility; these include a type of sperm DNA damage known as sperm DNA fragmentation (SDF). Doctors and researchers are still learning about SDF, including what causes it, how it can be treated, and how it impacts fertility.

While both men and women can experience sexual function issues that affect fertility, erectile dysfunction (ED) in men can be one of the more common and problematic. The physical aspect of ED can mean an inability to perform during intercourse and an impeded ability to deliver sperm. However, ED can also be a sign of other health problems and may lead to emotional distress for men, especially when trying to conceive. Understanding what causes ED, who may be most at risk, and how it can be treated are all critical elements for reaching one’s fertility goals.

Sperm, or spermatozoa, are the reproductive cells (gamete) of a biological male. The reproductive cell of a biological female is called an oocyte, ovum, or egg. The primary function of sperm is to reach and fuse with an egg. This allows the sperm to deliver male genetic information (DNA) into the egg. In doing so, a zygote (fertilized egg) is formed, which can then go through stages of development to form a fetus. Human DNA is contained within structures called chromosomes, which are found inside the nucleus of every cell. Most human cells are diploid cells, meaning they contain two sets of 23 chromosomes—one set from the sperm and one set from the egg that made them. Sperm and egg cells, however, are haploid cells, and contain a single set of 23 chromosomes. When a sperm fuses with an egg, the newly formed zygote will have two sets of chromosomes, one from the sperm and one from the egg. This is how most human cells end up with a total of 46 chromosomes. Sperm production occurs inside male testes (testicles). Unlike biological females, who are born with all the eggs they will ever produce in their lifetime, biological males start to produce sperm once they reach puberty and will continue making sperm throughout their lifespan. Sperm are also called spermatozoa (plural) or spermatozoon (singular). The term “sperm” can be singular or plural.

Varicocele is a fairly common condition affecting the male reproductive system. Many men have varicoceles, but not all varicoceles cause problems. In some men, varicoceles lead to issues such as testicular pain, decreased sperm count, and decreased sperm quality that can affect fertility. For these individuals, varicocele treatment can help.