Treatment depends on what's causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into 3 categories:
- Non-surgical therapy for Male Infertility
- Surgical Therapy for Male Infertility
- Treatment for Unknown Causes of Male Infertility
Non-Surgical Treatment for Specific Male Infertility Conditions
Many male infertility problems can be treated without surgery.
Anejaculation is when there's no semen. It's not common, but can be caused by:
- spinal cord injury
- prior surgery
- multiple sclerosis
- abnormalities present at birth
- other mental, emotional or unknown problems
Drugs are often tried first to treat this condition. If they fail, there are 2 next steps. Rectal probe electroejaculation (RPE, better known as electroejaculation or EEJ) is one. Penile vibratory stimulation (PVS) is the other.
Rectal probe electroejaculation is most often done under anesthesia. This is true except in men with a damaged spinal cord. RPE retrieves sperm in 90 out of 100 men who have it done. Many sperm are collected with this method. But sperm movement and shape may still lower fertility.
Penile vibratory stimulation vibrates the tip and shaft of the penis to help get a natural climax. While non-invasive, it doesn't work as well as RPE. This is especially true in severe cases.
Assisted reproductive techniques like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are of great value to men with anejaculation.
Congenital Adrenal Hyperplasia (CAH)
CAH is a rare cause of male infertility. It involves flaws from birth in certain enzymes. This causes abnormal hormone production. CAH is most often diagnosed by looking for too much steroid in the blood and urine. CAH can be treated with hormone replacement.
Genital Tract Infection
Genital tract infection is rarely linked to infertility. It's only found in about 2 out of 100 men with fertility problems. In those cases, the problem is often diagnosed from a semen test. In the test, white blood cells are found. White blood cells make too much "reactive oxygen species" (ROS). This lowers the chances of sperm being able to fertilize an egg. For example, a severe infection of the epididymis and testes may cause testicular shrinking and epididymal duct blockage. The infection doesn't have to be sudden to cause problems.
Antibiotics are often given for full-blown infections. But they're not used for lesser inflammations. They can sometimes harm sperm production. Non-steroidal anti-inflammatories (such as ibuprofen) are often used instead.
Inflammation from causes other than infection can also affect fertility. For example, chronic prostatitis, in rare cases, can also block the ejaculatory ducts.
Hyperprolactinemia is when the pituitary gland makes too much of the hormone prolactin. It's a factor in infertility and erectile dysfunction. Treatment depends on what's causing the increase. If medications are the cause, your health care provider may stop them. Drugs may be given to bring prolactin levels to normal. If a growth in the pituitary gland is found, you may be referred to a neurosurgeon.
Hypogonadotropic hypogonadism is when the testicles don't make sperm due to poor stimulation by the pituitary hormones. This is due to a problem in the pituitary or hypothalamus. It's the cause of a small percentage of infertility in men. It can exist at birth ("congenital"). Or it can show up later ("acquired").
The congenital form, known also as Kallmann's syndrome, is caused by lower amounts of gonadotropin-releasing hormone (GnRH). GnRH is a hormone made by the hypothalamus. The acquired form can be triggered by other health issues such as:
- pituitary tumors
- head trauma
- anabolic steroid use.
If hypogonadotropic hypogonadism is suspected, your health care provider may want you to have an MRI. This will show a picture of your pituitary gland. You will also have a blood test to check prolactin levels. Together, an MRI and blood test can rule out pituitary tumors. If there are high levels of prolactin but no tumor on the pituitary gland, your provider may try to lower your prolactin first. Gonadotropin replacement therapy would be the next step. During treatment, blood testosterone levels and semen will be checked. Chances for pregnancy are very good. The sperm resulting from this treatment are normal.
Scientists first showed that some infertility cases were linked to immune system problems in the early 1950s. There has been much research since then. Though steroids (by mouth) are sometimes used to lower antisperm antibodies, this rarely works. In vitro fertilization with Intracytoplasmic Sperm Injection (ICSI) is now preferred for fertility problems caused by the immune system. This abnormality is very rare.
Reactive Oxygen Species (ROS)
ROS are small molecules found in many bodily fluids. They are in white blood cells. They are also in the sperm cells in semen. ROS can help prepare the sperm for fertilization. But too much ROS can hurt other cells. Sperm are easily harmed by ROS. Recent studies have shown more ROS molecules in the semen of infertile men.
Many compounds have been used to detoxify or "scavenge" (fix) ROS levels. The most studied of these, Vitamin E (400 IU twice daily), can work well as an antioxidant. Pentoxifylline, coenzymeQ, and Vitamin C have also been shown to lower sperm ROS. They're used much less often than Vitamin E.
Retrograde ejaculation, semen flowing back instead of going out the penis, has many causes. It can be caused by:
- prostate or bladder surgeries
- spinal cord injury
- certain anti-hypertensives
- medications used to treat prostate enlargement (BPH)
Retrograde ejaculation is found by checking your urine for sperm. This is done under a microscope right after ejaculation. Drugs can be used to correct retrograde ejaculation.
It is often treated first with over-the-counter medications like Sudafed®. If medications don't work and you need assisted reproductive techniques (ARTs), your health care provider may try to collect sperm from your bladder after ejaculation.
Surgical Therapy for Male Infertility
Varicoceles can be fixed with minor outpatient surgery called varicocelectomy. Fixing these swollen veins helps sperm movement, numbers, and structure. For more information on varicocele treatments please refer to our Varicoceles page.
If your semen lacks sperm (azoospermia) because of a blockage, there are many surgical choices.
Vasovasostomy is used to undo a vasectomy. It uses microsurgery to join the 2 cut parts of the vas deferens in each testicle. For more information on this treatment please refer to our Vasectomy Reversal page.
Vasoepididymostomy joins the upper end of the vas deferens to the epididymis. It's the most common microsurgical method to treat epididymal blocks. For more information on this treatment please refer to our Vasectomy Reversal Page.
Transurethral Resection of the Ejaculatory Duct (TURED)
Ejaculatory duct blockage can be treated surgically. A cystoscope is passed into the urethra (the tube inside the penis) and a small incision is made in the ejaculatory duct. This gets sperm into the semen in about 65 out of 100 men. But there can be problems. Blockages could come back. Incontinence and retrograde ejaculation from bladder damage are other possible but rare problems. Also, only 1 in 4 couples get pregnant naturally after this treatment.
Treatment for Unknown Causes of Male Infertility
Sometimes it's hard to tell the cause of male infertility. This is called "non-specific" or "idiopathic" male infertility. Your health care provider may uses experience to help figure out what works. This is called "empiric therapy." Because infertility problems are often due to hormones, empiric therapy might balance hormone levels. It's not easy to tell how well empiric treatments will work. Each case is different.
Assisted Reproductive Techniques
If infertility treatment fails or isn't available, there are ways to get pregnant without sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and the cause, your health care provider may suggest:
Intrauterine Insemination (IUI)
For IUI, your health care provider places the sperm into the female partner's uterus through a tube. IUI is often good for low sperm count and movement problems, retrograde ejaculation, and other causes of infertility.
In Vitro Fertilization (IVF)
IVF is when the egg of a female partner or donor is joined with sperm in a lab Petri dish. For IVF, the ovaries must be overly stimulated. This is often done with drugs. It allows many mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is put back into the uterus. IVF is used mostly for women with blocked fallopian tubes. But it's being used more and more in cases where the man has very severe and untreatable oligospermia (low sperm count).
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a variation of IVF. It has revolutionized treatment of severe male infertility. It lets couples thought infertile get pregnant. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it's put in the female partner's uterus. Your health care provider may use ICSI if you have very poor semen quality. It is also used if you have no sperm in the semen caused by a block or testicular failure that can't be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method.
Sperm Retrieval for ART
Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract. These methods include:
Testicular Sperm Extraction (TESE)
This is a common technique used to diagnose the cause of azoospermia. It also gets enough tissue for sperm extraction. The sperm taken from the testicle can be used fresh or frozen ("cryopreserved"). One or many small biopsies are done, often in the office.
Testicular Fine Needle Aspiration (TFNA)
TFNA was first used to diagnose azoospermia. It is now sometimes used to collect sperm from the testicles. A needle and syringe puncture the scrotal skin to pull sperm from the testicle.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA, like TFNA, can be done many times at low cost. There is no surgical cut. More urologists can do it because it doesn't call for a high-powered microscope. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis. Then he or she gently withdraws fluid. Sperm may not always be gotten this way. You may still need open surgery.
Microsurgical Epididymal Sperm Aspiration (MESA)
With MESA, sperm are also retrieved from the epididymal tubes. This method uses a surgical microscope. MESA yields high amounts of motile sperm. They can be frozen and thawed later for IVF treatments. This method limits harm to the epididymis. It keeps blood out of the fluid. Even though MESA calls for general anesthesia and microsurgical skill, it has a lower problem rate. It's also able to collect larger numbers of sperm with better motility for banking.