Let’s Talk About the Silent Condition of Male Infertility

When a couple struggles with getting pregnant, many assume the woman is infertile. But consider these numbers: 

• In one-third of couples, the problem is with the man. In one-third of couples, the problem is with the woman.
• In one-third of couples, the problem is not found, or it is with both the woman and the man.

Source: National Institutes of Health

“There’s a cultural misunderstanding of infertility,” says George R. Attia, M.D., MBA, an obstetrician/gynecologist specializing in reproductive endocrinology and infertility and associate director of the Division of Reproductive Endocrinology and Infertility at the University of Miami Health System. His colleague, Thomas Masterson, M.D., a UHealth urologist specializing in male infertility, agrees. “The zeitgeist in popular culture is that infertility is a female issue; it’s never the guys.” 

Male infertility should be part of any fertility workup, which is why we take a comprehensive approach. 

Dr. Attia

Partnering with an academic medical center, like UHealth, gives couples access to a multidisciplinary team of experts, including male and female fertility specialists, in one location. 

“Male infertility is a silent condition. You do not know there’s a problem until you try to have children,” Dr. Masterson says. 

There is a silver lining: male infertility is much easier to diagnose than female infertility. “A simple semen analysis is the cornerstone of diagnosis,” Dr. Masterson says. The test evaluates sperm count, movement, and shape. 

If traditional beliefs say the “fault” lies with the woman, what other myths persist? 

Dr. Attia and Dr. Masterson encounter different reactions from male patients. When a semen analysis reveals a fertility issue, patients may respond with denial or surprise. 

“They’ll say, ‘I had a kid ten years ago.’ Although men don’t have the biological timeline women have, their sperm count may have been high enough for their wife in her 20s, but it’s not enough now that she’s in her 30s,” Dr. Masterson says. Some men also falsely conclude that there’s no way to fix the problem. For the most part, however, male infertility is treatable.

Dr. Attia finds that men tend to personalize fertility problems.

“Men take fertility problems as a strike against their manhood.” Dr. Masterson agrees, saying, “They see it as emasculating.”

Another major misconception the doctors have to dispel is that taking testosterone exogenously (from an external source) enhances fertility. A 2013 study found that taking testosterone this way decreased sperm production. Though most men produced a normal amount of sperm within a year of stopping testosterone use. 

How your lifestyle affects your fertility

If your sperm could talk, they might sound suspiciously like your wife or partner.

“Please stop smoking, lose weight, drink less, manage your stress, don’t work so hard, and get more sleep!” 

Our bodies respond to how we treat them. 

Just as women experiencing extreme stress may stop menstruating, lifestyle factors affect men’s fertility. 

“From a biological standpoint, it doesn’t pay off for your body to make more sperm if you’re unhealthy,” Dr. Masterson says.  

Identifying the silent condition

While the infertility focus still is on women in many clinics, couples seeking help at UHealth’s Reproductive and Fertility Center have both female and male fertility evaluated. 

“It is a combined workup. We also look for any underlying conditions that may affect fertility,” Dr. Attia says. 

Dr. Masterson agrees though he says their fertility practice is unique in that way. “We often see couples who have had a full female evaluation without ever screening the male.”

To resolve infertility issues, the physicians and their colleagues leave no stone unturned. “We communicate with each other all the time. Our approach is comprehensive and holistic, which allows a better chance of a successful outcome,” Dr. Attia says.  

After all, when the wait is over, and you’re holding that “successful outcome” in your arms, wasn’t it all worth it? 

To schedule a consultation with Dr. Attia, call 305-243-8642. To schedule a consultation with Dr. Masterson, call 305-243-6090. 

Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: Dr. George Attia, Dr. Thomas Masterson, fertilized eggs, healthy sperm, men and women, reproductive medicine, risk of infertility