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Male Infertility

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Dr. Lawrence Jenkins

What are our chances of getting pregnant?

For a typical heterosexual couple, the likelihood of pregnancy ranges from 20% to 37% within three months, 75% within six months, and 90% within one year. If conception doesn’t happen in the first year, around 50% of couples will achieve pregnancy in the following year. If attempts to conceive are unsuccessful for more than a year, or sooner if the woman is over 35, seeking advice from a fertility specialist is advisable. About 20% of infertility cases are attributed to male factors alone, while 30% involve both male and female factors.

How is male fertility evaluated?

Male fertility evaluation begins with a physical exam and medical history, followed by a semen analysis. The semen, collected through masturbation in a sterile container, provides crucial information about sperm quantity, movement, and shape. If the results are normal, it is likely that the man is reproductively healthy. Abnormal results may prompt further evaluation. Hormone blood tests can also aid in assessing male fertility issues, recognizing that factors affecting sperm may have occurred within the previous three months.

How often should a couple have intercourse?

To optimize the chances of pregnancy, couples should engage in intercourse two to three times a week during the fertile period. Having intercourse every one to two days during the fertile window increases the likelihood of conception, with the most favorable timeframe being within the six-day period ending on the day of ovulation.

Are there practices that can improve our chances of getting pregnant?

Sperm reach the fallopian tubes within minutes of ejaculation, regardless of intercourse position. Orgasm or prolonged rest after intercourse doesn’t enhance the chances of pregnancy. However, the use of some lubricants, including commercial products and substances like saliva, olive oil, and KY Jelly®, during the fertile period may hinder sperm movement. Consulting with a doctor about safe lubricant choices is recommended.

Does diet affect fertility?

Obesity is linked to impaired sperm production. Men seeking optimal fertility should strive for an ideal body weight. Antioxidants like vitamins E and C, present in most multivitamins, may slightly increase sperm count and movement. A balanced diet with fruits and vegetables provides natural antioxidants.

What are the effects of smoking and recreational drug use?

Smoking is associated with reduced sperm quality, and men trying to conceive should consider quitting immediately. Recreational drugs, including anabolic steroids and marijuana, are linked to impaired sperm function and production and should be avoided.

Are boxers or briefs better?

While inconclusive, some studies suggest that brief underwear may raise scrotal temperature, potentially impacting sperm quality. Choosing boxers may help mitigate this effect. Regardless, avoiding situations that elevate scrotal temperature, such as hot tubs or using laptops on the lap, may improve sperm quantity and quality.

What else can affect my sperm?

Certain medications, chronic medical conditions, and high fevers can impair sperm production. Consult your doctor to understand how your medications or conditions may affect fertility potential.

How can I improve our chances of getting pregnant?

Adopting a healthy lifestyle can enhance male fertility. Maintaining an ideal weight, consuming a diet rich in antioxidants, taking multivitamins, managing stress, and controlling chronic medical conditions can positively impact sperm quality. Remember that lifestyle changes may take about three months to reflect improvements in sperm. Couples with underlying medical or genetic conditions should seek advice from a doctor to ensure the best approach to fertility.

What is a Vasectomy Reversal?

A vasectomy reversal is a procedure for men who have previously undergone a vasectomy and now wish to father a child. This surgical intervention reconnects the vas deferens, creating a pathway for sperm to reenter the semen. Typically, the cut ends of the vas are reattached, and in some cases, they may be joined to the epididymis. Microsurgery, conducted under a specialized microscope, is often employed to enhance precision. This process allows sperm to flow through the urethra once again.

The success of the reversal is highest when performed sooner rather than later after the vasectomy, with faster sperm return to the semen. It’s crucial to inquire early in the planning process whether your health plan covers reversal procedures, as most health plans do not.

How is a Vasectomy Reversed?

Vasectomy reversals can be carried out in an outpatient setting within a hospital or a surgery center. If microsurgery is utilized, the procedure is typically performed while the patient is under anesthesia. Your urologist and anesthesiologist will discuss your options with you.


Microsurgery is the preferred method for successful vasectomy reversals. During the surgery, a high-powered microscope magnifies the small tubes 5 to 25 times their size, allowing the urologist to use ultra-thin stitches to join the ends of the vas.


While you are under anesthesia, the urologist will make small incisions on each side of the scrotum, removing the scarred ends of the vas closed during the vasectomy. Vasal fluid is then extracted and examined under another microscope to determine the presence of sperm.

Two types of reversal procedures are currently performed:

Vasovasostomy directly reconnects the ends of the vas. When microsurgery is employed, vasovasostomy is successful in about 95 out of 100 men.

Vasoepididymostomy is more intricate and performed when a blockage affects another portion of the vas deferens or testicular tissue. This procedure works around the blockage, joining the upper end of the vas to the epididymis. Vasoepididymostomy has a success rate of about 70 out of 100 men.

Consider freezing your sperm during the reversal in case the microsurgery is not as effective as planned.

After Treatment

The recovery process is typically swift and manageable, with post-surgery pain often controlled using oral medication. Pain severe enough to require medication seldom lasts beyond a few days to a week.

Most men can resume their normal routine and light work within a week, and more strenuous activities and sexual activity can often be resumed within 2 to 3 weeks after surgery. If your job involves strenuous activities, consult your urologist regarding the appropriate time to return to work.

Achieving pregnancy after vasectomy reversal may take four months to a year. Testing sperm count is the primary method to assess the success of the surgery, with periodic semen analysis recommended by your urologist until sperm count stabilizes or pregnancy occurs. Sperm may appear in the semen within a few months after vasovasostomy, while vasoepididymostomy may take between 3 to 15 months.

What are Varicoceles?

Varicoceles occur when the veins inside the scrotum (the sac that holds the testicles) become enlarged due to poor blood flow. These veins, known as the pampiniform plexus, may appear like a “bag of worms” when they grow larger. Varicoceles are more prevalent on the left side, affecting ten to fifteen men out of one hundred. This condition is analogous to developing varicose veins in the leg.

In most cases, varicoceles are benign and do not cause issues. However, they can lead to pain, fertility problems, or hinder the growth of the testicles in young boys.

Normal Functionality:

The scrotum houses the testicles (testes) of the male reproductive system, responsible for producing sperm and the hormone testosterone. The spermatic cord supports the testicles, containing nerves, the vas deferens (the tube carrying sperm), the testicular artery, and the pampiniform plexus. This cluster of small veins helps cool the testicles to support the production of high-quality sperm. Enlargement of these veins (varicocele) can result in overheating of the testes, leading to diminished sperm quality.

Varicocele Symptoms & Diagnosis:

Most men with varicoceles do not experience symptoms, but the condition can cause infertility or impede the growth of the left testicle during puberty. Self-exams and routine medical examinations are common methods of detecting varicoceles. A scrotal ultrasound may be ordered by a urologist to visualize the scrotum’s interior.

Causes of Varicocele:

Several factors can contribute to the development of varicoceles. Malfunctioning or absent valves in the veins, sluggish blood flow leading to blood pooling, and weak blood pressure causing backward flow and vein swelling are potential reasons. In rare cases, swollen lymph nodes or masses behind the abdomen can obstruct blood flow, resulting in swollen scrotal veins.

Treatments for Varicocele:

Varicoceles are often left untreated unless fertility issues, abnormal semen, or slow testicle growth in boys necessitate intervention. There are no specific drugs for varicoceles, but over-the-counter pain medication may provide relief.


If necessary, surgery is the primary treatment option. Microscopic or laparoscopic surgery involves ligating (tying or removing) the veins to prevent blood pooling. Another option is embolization, where a tiny coil and/or fluid is placed in the blood vessel to redirect blood flow away from the varicocele. Recovery after surgery is usually quick, with mild pain, and additional fertility treatments may be considered.


Most men will not encounter problems if they opt not to treat varicoceles.

Treatment may be advisable if there is pain, asymmetry in testicle size, or abnormal semen at age 16. Consult a urologist.

Support the scrotum with a jockstrap or briefs-style underwear, lie on your back to aid drainage, and consider over-the-counter pain relievers.

Consult a doctor to rule out testicular cancer if any lump or bump is detected in the testicle.

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