Male Infertility

Conception is complicated. A lot of things have to work together, and this doesn’t always happen. And there can be many reasons why. Your body might not make enough sperm — or none at all. Or maybe they aren’t healthy or fast enough to successfully fertilize an egg. Or you might have other health conditions or damage to your reproductive organs that could affect your fertility.

What to expect at your first appointment

When you meet with us for the first time, you’ll want to be prepared to answer a lot of questions about your health, medical history and your attempts to conceive with your partner.

Don’t be surprised if we also ask about your lifestyle, because a lot of things can contribute to infertility. Having had a vasectomy, smoking, drinking heavily, using recreational drugs or having obesity can all have an impact on how many sperm leave your body and how healthy they are. It’s important for us to know all about these things so we can build the right treatment plan for you.

Your provider may also order some tests to pinpoint exactly what’s causing your infertility. And they’ll use the results of these tests to design a personalized care plan for you.

Blood tests

Your provider may have you do some blood tests. We can learn a lot from a blood sample, like if you have a hormone imbalance (low testosterone). If you do, it might mean you have a low sperm count (not enough sperm). Or maybe it can explain why you’re having problems keeping or getting an erection (erectile dysfunction).

Semen and sperm analysis

Another helpful test is a semen analysis, which helps us see how much sperm you can make, what shape they are and how well they swim. Knowing all of this helps us decide what kind of treatment might work. There are more sperm-related tests your provider can do, too, if they feel it’s necessary to dive deeper into what’s going on with how your body makes sperm and semen.

Ultrasound

Sometimes your provider will order a scrotal ultrasound to look at your testicles and see if there are any obvious problems. This test isn’t painful and only takes a few minutes.

Meet Our Male Infertility Team

At Cleveland Clinic, a team of caring, skilled healthcare providers from several different specialties will work with you to diagnose and treat your infertility. This team could include:

• Reproductive urologists.
• Reproductive endocrinologists for your partner.
• Pathologists.
• Radiologists.
• Nurse practitioners.
• Physician assistants.

Most of the time, if you have infertility, you’ll need treatment. Once we confirm your diagnosis, we’ll work with you to design a personalized treatment plan based on your test results, goals and your timeline. We understand this can be stressful, so we want to be sure each step of the plan is tailored to your needs.

Lifestyle changes

If you have infertility, you might need to make some lifestyle changes — like quitting smoking, cutting back on alcohol if you drink every day, reducing your caffeine intake, exercising more, eating a balanced diet and maintaining a weight that’s healthy for you. We can also work with you and your partner if you feel like you want to talk to a counselor about how you’re feeling about this infertility journey.

Medications

Sometimes medications can help with male infertility. Your provider might recommend taking pills to help signal your testicles to work harder or to increase your testosterone levels.

Intrauterine insemination (IUI)

If your semen and sperm tests show you don’t have enough sperm in your semen, or they don’t move fast enough, we might suggest that you and your partner try to conceive by intrauterine insemination (IUI). IUI moves your concentrated sperm directly to your partner’s uterus through a quick (20-minute), minimally invasive process.

In vitro fertilization (IVF)

For couples dealing with male infertility, we often recommend in vitro fertilization as a frontline treatment. We’ll ramp up your partner’s ovaries with fertility medications that’ll cause multiple eggs to mature and be ready for fertilization. When they’re ready, we’ll collect the eggs in a short, minimally invasive procedure. We’ll also have your sperm to fertilize the egg with.

Intracytoplasmic sperm injection (ICSI) is one of the newest ways to do this. Our embryologists will inject a single sperm into your partner’s mature egg. It can often work for even the most severe male infertility cases. Or sometimes, we’ll put your partner’s mature eggs with your sperm in a culture (petri) dish that’s kept in a safe growth environment.

Once the egg is fertilized, it’s called an embryo. We’ll keep the embryos in secure incubators with a built-in camera and microscope (EmbryoScope®). This system lets us keep an eye on them for about five or six days. If all looks good, we’ll choose the healthiest embryo and put it in your partner’s uterus so it can implant (attach) and continue to grow.

Surgery

• Vasectomy reversal: If you have a blockage in your vas deferens (tube in your scrotum that transports sperm) from a vasectomy, you might need this surgery to fix things. Your surgeons will find your vas deferens and bypass the blockage to restore sperm flow.
• Sperm retrieval: If your providers can’t find any sperm in your semen, they might make a small incision (cut) into your testicle to look for sperm directly at the source. This sperm can then be used for ICSI. They might also take a sample of your testicle tissue to see if they can learn more about what’s happening inside your body (testicular biopsy).

Fertility Preservation

Maybe you’re not ready to have kids now but know you want them in the future. Or perhaps you’re going to have cancer treatments, which could cause problems with your sperm. Or you might want to delay parenthood and are having a decline in sperm count — but you still want to make sure you have healthy sperm for future use.

At Cleveland Clinic, we offer fertility preservation options in our secure fertility lab. If you choose to do sperm banking, you can rest easy knowing your frozen (cryopreserved) sperm is stored in monitored storage tanks with alarm systems that notify us of even the tiniest change in temperature.

Taking the Next Step

Conception doesn’t always happen naturally. It’s ok if you and your partner need some help. You don’t have to face your male infertility alone or feel bad about it. At Cleveland Clinic, we’re here for you. We’ll do testing to figure out what’s causing problems. Then, we’ll put together a personalized treatment plan so you can move forward with your plans. Throughout the entire process, we’ll be by your side — guiding and supporting you.