A Mass General urologist provides facts about male infertility and offers expert advice about what to expect when you seek related care.

You might think of infertility as a problem faced mostly by women, but fertility problems are quite common for both men and women. And because fertility is complex, these problems can be difficult to diagnose no matter your gender.

Confronting infertility can be scary, confusing and stressful, but it’s helpful to learn more about what you can expect during treatment.

Confronting infertility can be scary, confusing and stressful, but it’s helpful to learn more about what you can expect during treatment. Urologist Ajay Nehra, MBBS, is director of Men’s Health and Male Reconstructive Surgery at the Fertility Center at Massachusetts General Hospital. He shares six things you should know about male infertility.

1. Infertility affects both men and women in nearly equal measures

Roughly one-third of infertility cases are related to the man and roughly one-third are related to the woman.

The remaining one-third of infertility cases are related to both partners or their cause can’t be identified.

2. Testing for male infertility is often done first

The process for evaluating male fertility is much less invasive overall. Quite simply, it’s easier for a man to collect a sperm specimen than it is to collect a sample of a woman’s eggs.

Fertility testing usually starts with a thorough medical history and physical exam, including an examination of the genitals. From there your doctor will decide what further testing is appropriate based on your current situation and medical history.

Ajay Nehra, MBBS
Ajay Nehra, MBBS

Common Components of Male Infertility Testing:

  • Comprehensive medical history
  • General physical exam
  • Semen testing – examines amount of semen produced during ejaculation, sperm concentration and movement of the sperm
  • Blood testing – checks testosterone and other hormone levels
  • Ultrasound
  • Genetics testing

3. Genetics play a big role in fertility for both men and women

As technology and our understanding of genetics improves, researchers are learning more and more about how genetics impact our individual fertility. If initial screenings like the semen analysis are not conclusive, your doctor may recommend genetic screening to look for genetic problems that may be affecting fertility (even if they aren’t impacting you otherwise).

“Many patients don’t realize that they may have genetic factors that play a huge role in their fertility,” says Dr. Nehra.

Genetic abnormalities can affect a man’s fertility by interfering with either sperm production or the movement of sperm out of the body. Certain genetic mutations, particularly those related to cystic fibrosis, and chromosomal abnormalities related to impairment of the testicles are the most common genetic causes of infertility.

“Many men assume that testosterone is the be all and end all when it comes to fertility, and it’s not.”

If you or your partner are facing any of these genetic issues, you can work with a genetic counselor to determine the best course of action to treat the infertility and avoid genetic issues in your children.

4. Male infertility is about more than testosterone

“Many men assume that testosterone is the be all and end all when it comes to fertility, and it’s not,” says Dr. Nehra. “There are a lot of pieces of the puzzle beyond testosterone.”

While testosterone certainly plays an important role in male fertility, it is far from the only factor that determines a man’s fertility. Your doctor will likely begin by evaluating many common causes.

Common Causes of Male Infertility:

  • Abnormal sperm production
  • Internal physical problems that interfere with the delivery of sperm from the penis to vagina
  • General health issues – i.e. obesity, malnutrition, stress, medical conditions like diabetes or HIV
  • Lifestyle factors – i.e. smoking, drug and alcohol use
  • Environmental factors – i.e. frequent contact with pesticides or other chemicals

5. Diagnosing infertility is often a process of elimination

Treating infertility is often about optimizing overall health for both members of the couple. Your doctor will work with you to make sure that the stage is set to optimize the environment for pregnancy.

“If we can identify physiologic factors, anatomical factors or hormonal imbalances, and then exclude or treat them, then we are on the path to really enhancing your overall care for infertility,” says Dr. Nehra.

Reproduction is complex. But many people don’t realize just how complex the process can be.

6. Treating fertility is complex & involves multiple specialties

Reproduction is complex. But many people don’t realize just how complex the process can be. The Mass General Fertility Center is made up of a multidisciplinary team that includes specialists in both urology and reproductive endocrinology.

“I think the most common misconception that couples have is that they don’t realize the uniqueness of the fertility practice and timing,” says Dr. Nehra. “They don’t realize the integrated practice that’s required among the reproductive endocrinology group, the urology group and the couple in facilitating a successful outcome.”

This seamless integration between specialties means that our center can serve both men and women in one convenient setting. By simplifying the process of seeking infertility care, we aim to provide an environment for successful pregnancy outcomes for our patients.

Visit the website of Mass General’s Male Infertility Program to learn more.

To support fertility programs and others within Mass General’s Department of Urology, please contact us.