Smoking, excessive alcohol, recreational drugs, anabolic steroids, and frequent hot tub/sauna use are among factors that are known to possibly be detrimental to male fertility.

Testing: Semen analysis

Treatment: Identify the reason and take steps to correct the problem (quit smoking, lose weight, etc.). Multivitamin with antioxidants. After any intervention, at least 3 months will be required before any improvement can be expected.

Chronic medical problems such as diabetes, high blood pressure, thyroid disease, and obesity can affect male sexual function and the quality and quantity of the sperm.

Testing: Semen analysis, possible hormone testing

Treatment: It is important to work with your GP to optimize the treatment of your medical condition. While many of these problems cannot be cured, making sure that you are on the best possible treatment will improve your general health and potentially increase your chances of initiating a natural pregnancy. Assisted reproduction, such as IUI or IVF-ICSI can help in situations when natural pregnancy does not occur.

A dilation of blood vessels in the scrotum causes abnormal circulation around the testicles, potentially affecting the normal production of sperm. If the dilated blood vessels are very large, varicocoeles can often cause testicular pain. However, many men with varicocele will not have any symptoms and can have normal fertility.

Testing: Semen analysis, Examination by a urologist; scrotal ultrasound

Treatment: Varicocele ligation or embolization are different techniques to restore normal circulation in the scrotum. These treatments are not always successful in restoring normal sperm production, so your urologist will discuss if you are a good candidate for such treatments. Assisted reproduction, such as IUI or IVF-ICSI can be used if sperm production can’t be restored.

Some men will produce sperm normally but release only a very small amount of semen due to a physical obstruction. Some men are born with such problems while others develop them over time. Depending on the nature of the blockage, only a small concentration of sperm may be present (oligospermia), while in others, no sperm will be present (azoospermia). There are numerous problems that can be responsible for an obstruction, thus a referral to a urologist for a full evaluation is necessary.

Testing: Semen analysis, Examination by a urologist, blood testing for hormones and genetics, scrotal ultrasound.

Treatment: Depending on the cause for the obstruction, the urologist will determine the most appropriate treatment. Options include surgical procedures to correct the obstruction, or minor procedures to obtain sperm to be used for IVF-ICSI.

Sometimes family plans change, and men wish to reverse the effects of a vasectomy.

Testing: Consultation with a urologist.

Treatment: A vasectomy reversal is a surgical procedure that can often restore natural fertility in men. Your urologist will discuss if you are a good candidate and how successful the procedure can be expected to be. An alternative is a percutaneous epididymal sperm aspiration (PESA) procedure, to obtain sperm for use in IVF-ICSI. Before deciding which procedure is appropriate, the evaluation of the female partner is important to consider.

Certain cancers or cancer treatments may prevent future sperm production. We recommend discussion with your oncologist about the possible sterilizing effects of cancer treatment, and a consultation with a fertility specialist to freeze sperm for future use. If you have already had cancer treatment, a semen analysis can determine if you are still producing sperm.

Treatment: Sperm can be frozen on an emergency basis so that cancer treatment need not be delayed. If possible, 2 specimens should be obtained so that multiple attempts at future pregnancies can occur, either through IUI or IVF/ICSI. For those who have already had cancer treatment, a semen analysis will determine if sperm is available for IUI or IVF/ICSI. If you are no longer producing sperm, donor sperm can be considered.