a4234_ITK_Male_cvr_In the KnowText 12/15/14 8:59 AM Page 1

in the

know

What No One Tells You

About Male Fertility

Brought to you by

2014 EMD Serono, Inc. All rights reserved. US-NON-0714-0014

EMD Serono, Inc. is a subsidiary of Merck KGaA, Darmstadt, Germany.

a4234_ITK_Male_cvr_In the KnowText 12/15/14 8:59 AM Page 2

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 1

chapter one
Understanding

Male
Infertility
I

t seems like no matter where you go or what you do, youll see
stereotypes of men who cant stop thinking about sex from
television and movies to advertising. The need to reproduce is
natural and the male anatomy is there to do its job. When it
doesnt and the reproductive functions fail, it can be difficult to accept. You may even think its an assault on your sexuality if you are
the cause for the failure to conceive. Getting your partner pregnant shouldnt be this hard, right?
Despite what cartoons might lead you to believe, sperm are not
simple, tadpole-type creatures. Furthermore, those little
swimmers arent all that tough, but the journey they undertake
from ejaculation to fertilization certainly is. The following may
shed some light on their inner workings.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 2

Understanding

Male Infertility

Sperm Production
Sperm are highly specialized
cells comprised of a head,
where genes are stored, and a
tail, which enables movement.
Sperm are produced by the
testes (testicles) located in the
scrotum and then passed
along to the epididymis, an
organ that stores and nourishes them as they mature and develop
movement. They start a two- to three-month process of development and movement from the testes, through the epididymis,
through the vas deferens, which goes from the scrotum through
the groin and then into the pelvis, and connects the epididymis to
the urethra. Seminal fluid is added by the prostate and other
glands as the sperm flow outside the body through the penis.6
During intercourse, sperm combine with fluid from the seminal
vesicle and prostate gland to create semen. Once deposited into
the womans vagina, sperm can live for 3-5 days within the female
reproductive tract, while retaining the ability to fertilize an egg.7
The average man has between 20 and 150 million sperm per
milliliter (mL) of ejaculate.8 If the sperm concentration is below
15 million per mL, a mans ability to impregnate his partner
naturally decreases significantly.9
Of the millions of moving sperm normally deposited into the
vagina, only a few hundred get close enough to the egg for
fertilization. Normal anatomy of the male reproductive organs
and balanced hormones are important for fertility.
You may want to discuss your history and any concerns with your
physician. There are various elements that can affect male fertility.
Consider the following list:

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 3

chapter one
Possible Causes for Male Infertility
Medical History
History of sexually transmitted disease (STD) 10
History of cancer treatment including surgery, chemotherapy
or radiation11
Use of anabolic steroids 11
Previous abdominal or urologic surgery or surgical sterilization 10
History of genital or prostate infection 11
Family history of cystic fibrosis or other genetic disorders12
Chronic medical condition, such as high blood pressure
or diabetes 11
Certain types of prescription drugs 10
Mumps after puberty 6
Male fertility decreases with age; the older the man is, the
longer it takes the couple to get pregnant, and the more likely
the partner is to miscarry 13

Lifestyle and Environment

Certain lifestyle factors can impact your fertility. Talk to your
doctor to see if changing one of these aspects of your life could
make a difference:
Prolonged exposure to high heat (e.g., hot tubs, whirlpools) can
lower sperm quality 11
Alcohol consumption and smoking have been shown to
compromise fertility in men11
Many lubricants, including petroleum jelly or vaginal creams,
may affect sperm quality 14

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 4

Understanding

Male Infertility

Exposure to toxic substances such as pesticides, radioactivity

or X-rays may lead to sperm abnormalities11
Increased scrotal temperature (e.g., prolonged sitting and use
of laptop computers on your lap) may hurt sperm production11
Illegal drug use, such as cocaine or inappropriate use of
prescription drugs, can affect sperm production and function11

Physical Changes to the Body

Additional medical issues that could contribute to infertility
include:

Cancer a small percentage of patients that present with

male infertility may have an underlying cancer,15 (testicular
germ cell cancer) which can be identified by a thorough
physical examination by a male fertility specialist

Varicocele (large veins around the testicles) the most

common cause of identifiable male infertility occurs when
varicose veins are present around one or both testicles which
can hinder sperm number and movement or function6

Erectile dysfunction the inability to get or sustain

an erection6

Undescended testes testes not reaching its normal position

in the scrotum, causing it to function abnormally and potentially not produce sperm16

Retrograde ejaculation ejaculate containing the sperm flows

backwards into the bladder instead of leaving the penis6

Atrophy of the testes could be a sign of abnormal genes that

cause infertility or a hormone imbalance17

The Bottom Line: Once diagnosed, many of these causes may

be treatable, so talk to your doctor as soon as possible.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 5

chapter one
All About Sperm
Several factors play a role
in determining success5:

Sperm count
(number of sperm)
Sperm motility
(ability to move)
Forward progression
(quality of movement)
Sperm morphology
(size and shape)
Semen volume
(amount of fluid that is released)

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 6

Can This
Be

Fixed

chapter two
A fter you have reviewed your medical history in detail and

completed a physical exam, including a blood and semen

analysis and any other tests you might need, your doctor may
recommend starting treatment. This is why you went to a
urologist or male fertility specialist. While it may not be the
answer you wanted to hear, it is a positive first step.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 7

chapter two
Ways to Treat Male Infertility
Minor Procedures to Fix Varicoceles Repair of these big
veins around the testes result in improved sperm quality6

Hormone Therapy Medication that may reverse hormone

imbalances and improve sperm production.6 Some hormone
treatments can worsen male infertility, such as pure testosterone11, so discuss this thoroughly with a fertility specialist.

Treat Infections of the Genital Tract Some infections may

harm sperm, but can be treated with appropriate antibiotic
therapy or non-steroidal anti-inflammatories.6

Reconstructive Procedures Treats blockages of the male

reproductive tract in the vas deferens, epididymis and
ejaculatory duct.6

Electroejaculation Rectal probe electroejaculation (RPE)

or penile vibratory stimulation (PVS) produces ejaculation
when neurological dysfunction prevents it.6

Sperm Retrieval Obtains sperm from the testes or

epididymis. The retrieved sperm then is processed to
identify and prepare the healthiest sperm for IUI or IVF.6

Intrauterine Insemination In addition to increasing the

number of eggs retrieved, sperm is inserted directly into
the uterus near the time of ovulation6

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 8

Can This Be

Fixed?

Assisted reproductive technology (ART) ART treatments

involve obtaining sperm through normal ejaculation, surgical
extraction or from donor individuals, depending on your
specific case and wishes. The sperm is then inserted into
the female genital tract, or used for in vitro fertilization or
intracytoplasmic sperm injection.6

In Vitro Fertilization (IVF) Used to overcome a variety of

fertility difficulties, particularly tubal problems and severe
sperm deficiencies. During IVF, medications are often used
to stimulate the development and release of a womans eggs.
The eggs and sperm are then collected and placed together
in a laboratory dish to fertilize. If successful, the embryo(s) is
transferred into a womans uterus for implantation.19

Intracytoplasmic Sperm Injection (ICSI) Used in conjunction

with IVF in which a laboratory technician, using a microscope,
injects a single sperm directly into each egg. ICSI is often used
if the male partner has very low sperm count, low sperm motility
or poor-quality sperm. If fertilization occurs after ICSI, the
embryo(s) is transferred into the uterus.19
Remember, there are many treatments and options available to
build your family. Plus, treatment options depend on the factors
causing your infertility. Learn as much as you can, and dont be
afraid to ask questions.

The Bottom Line: Your doctor will help get you through the
medical jargon and your treatment; there are other resources
like Fertility LifeLines and the Society for the Study of Male
Reproduction to help get you through the rest.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 9

chapter three
Getting
Through the

Stress
B

efore you agree to undergo any treatment, take some time to

think about what questions you have for your doctor. There is a list
in Chapter 4 to help get you started.
Knowing that you might have fertility issues can impact your sense
of masculinity. Unfortunately, the added anxiety you might feel while
going through all of this can also affect your sex life.20 Going through
reproductive issues can be extremely nerve-racking and even lead
to low self-esteem, depression and marital problems.20 You may lose
the urge, or when you try, you may struggle to achieve or maintain
an erection.3 The stress of infertility may be preventing you from
having sex, but you need to have sex in order for your partner to
get pregnant. However, there is treatment for this problem, which is
typically only temporary.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 10

Getting Through the

Stress

It has been found that a lack of knowledge combined with fear might
be an underlying factor in a mans reluctance to seek or continue
medical treatment for this condition.21 Additionally, men struggling
with infertility have reported fearing others will judge them as
inadequate.21 While it might seem easier to keep it all to yourself
and men often want to skip this part, hoping to be able to take
decisive action and move on you should be proactive. By taking
some small steps, you may improve your sex life and your relationship, and work toward finding a solution to your fertility problems.
Use these tips to help you get through those tough times:

Take control. By taking the initiative to educate yourself, you are

taking control of the problem. Understand the process
as best as you can by asking questions at the doctors office and
learning more through Web sites such as
FertilityLifeLines.com, SSMR.org and ASRM.org.

Find a way to blow off steam. Do anything to get your blood

pumping and shake off those thoughts of self-doubt. Work out.
Shoot hoops. Go running. When you release stress this way, you
also release endorphins22 and might even give your libido a boost.

Have the difficult conversation. We all know that men and women
communicate differently, but infertility is something you will have
to deal with together. Most women want to discuss infertility at
every turn not only the medical aspects and decisions, but also
all of their feelings and yours too. Be upfront when you need a
break from the topic, but be open to talking about it as well. You
need to tell your partner when YOU want to talk, or when you
just want to vent.
What I need from you to get through this is
What can I do to best support you throughout this process?
What are we willing to tell our family and friends?
How do you want me to handle it if my family is pushing
us for answers?

10

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 11

chapter three
Give your partner some TLC. Remember, you may have
only started thinking about what fatherhood will be like, but
chances are your partner played mommy with her dolls
when she was young and has thought about it ever since.
Acknowledge the stress of the situation and assure her that
you are in this together. You cant take the pain away, but just
being there for your partner will help. Let her talk, cry and
share her feelings. Surprise her with flowers, or plan a date
night or weekend getaway. Have sex for the pleasure of it
not just when the time and temperature are right. It will
remind her and you that you were a couple before you
wanted to have a baby, and youre still one.

Get support. This is a lot to deal with, so if you need to talk to

someone, thats okay. There are a lot of great support groups
and counselors out there. Ask your doctors office about
where you can get additional help if you need it.

The Bottom Line: If your stress interferes with your daily

routine or is having a negative impact on your sex life or
your relationship, take the steps to see how you can turn
this around.

11

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 12

chapter four
Your

Game Plan
M

any couples become overwhelmed trying to sort out the

medical jargon and insurance coverage. To help ease your
frustrations, below is your game plan a checklist of questions
and resources to help focus your attention on whats important.

Where to Turn for Help

The following organizations provide information and support:
Fertility LifeLines

www.FertilityLifeLines.com

Society for the Study of Male Reproduction

www.ssmr.org

Mens Health Network

www.menshealthnetwork.org

American Society for Reproductive Medicine www.asrm.org

RESOLVE: The National Infertility Association www.resolve.org
The American Fertility Association

12

www.theafa.org

Fertile Hope

www.fertilehope.org

Conceive

www.conceiveonline.com

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 13

chapter four
Questions for Advocacy Organizations
What kinds of programs and services do you offer?
Are there any materials or programs specifically for men?
Do you have a local chapter or any upcoming events in my area?
Do you offer any financial assistance programs?

Questions for Your Doctor

What specific tests would you recommend to diagnose
our infertility?
Based on the test results, what are my treatment options
and how much do they cost?
What should I expect from each treatment option and
what are the risks?
What is the national success rate for those treatments
in terms of live births?
How long have you been doing this and what is your success rate?
What is the time frame for moving on to the next phase of
treatment, if needed?
How will I communicate with you during this whole process?
Can you confirm what is covered by my health insurance policy?
Do you offer a payment plan or work with any organizations that do?
Does your center work closely with a male fertility specialist
to help determine the cause of my infertility and rule out any
associated serious medical conditions?
Does your center provide emotional counseling or can you
refer me to a counselor who deals with fertility problems?
How will my sex life be impacted by my infertility or treatment?

13

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 14

Your

Game Plan

Questions for Your Insurance Company and Employer

Many insurers offer coverage for the various stages of infertility
treatment from examinations and tests, to medical procedures
and drugs. Many states also have laws that address fertility coverage.
You should consult with your insurance agent or human resources
department to determine your coverage. Fertility LifeLines can
also help you determine and verify your coverage by visiting
www.FertilityLifeLines.com or calling the hotline at 1-866-LETS-TRY
(1-866-538-7879). All calls are free and confidential.
What is the definition of infertility in the contract?
What coverage is listed and where can I obtain a printed copy?
Is there a list of fertility specialists and clinics that are covered?
What procedures require preauthorization by the
insurance company?
Are there restrictions on the type of healthcare provider who
can perform fertility services?
What limits, if any, apply to my coverage in terms of treatment
cycles, procedures, months in therapy, etc.?
What is the process for appealing a claim that has been denied?
Are infertility drugs covered under the pharmacy benefit or
medical benefit?
Are there any benefit programs that might be helpful, such
as Employee Assistance Programs and Healthcare Savings
Accounts?

The Bottom Line: Youve hit a speed bump on your road to

fatherhood, but there are many resources to help get you
back on track.

14

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 15

References
1

Anderson, J.E., Farr, S.L., Jamieson, D.J., Warner, L., Macaluso, M. (2009).
Infertility services reported by men in the United States; national survey data.
Fertility and Sterility. Abstract. Retrieved on July 14, 2014, from
http://www.fertstert.org/article/S0015-0282(08)00593-1/abstract

American Society for Reproductive Medicine. (n.d.). Frequently Asked

Questions about Infertility. Retrieved July 14, 2014, from
http://www.asrm.org/awards/index.aspx?id=3012

Clay, R. A. (2006). Battling the self-blame of infertility. Monitor on Psychology,

37(8): 44. Retrieved July 14, 2014, from http://www.apa.org/monitor/sep06/
self-blame.html

RESOLVE. (2011). Fast Facts about Infertility. Retrieved July 14, 2014, from
http://www.resolve.org/about/fast-facts-about-fertility.html

American Society for Reproductive Medicine. (2008). Diagnostic Testing for

Male Factor Infertility. Retrieved July 14, 2014, from http://www.asrm.org/
FACTSHEET_Diagnostic_Testing_for_Male_Factor_Infertility/

UrologyHealth.org. (2012). Management of Male Infertility. Retrieved July 14, 2014,

from http://www.urologyhealth.org/urology/index.cfm?article=29&display=1

MayoClinic.com (2012) Getting Pregnant. Retrieved July 10, 2014, from

http://www.mayoclinic.org/healthy-living/getting-pregnant/expert-answers/
pregnancy/faq-20058504

Medline Plus. (2012) Semen Analysis. Retreived on July 14, 2014 from,
http://www.nlm.nih.gov/medlineplus/ency/article/003627.htm

MayoClinic.com. (2012). Low Sperm Count. Retrieved July 14, 2014, from
http://www.mayoclinic.com/health/low-sperm-count/DS01049/
DSECTION=tests-and-diagnosis

10

Medline Plus. (2012). Medical Encyclopedia: Infertility. Retrieved July 14, 2014,
from http://www.nlm.nih.gov/medlineplus/ency/article/001191.htm

11

MayoClinic.com. (2012). Low Sperm Count. Retrieved July 14, 2014,

http://www.mayoclinic.com/health/low-sperm-count/DS01049/
DSECTION=causes

12

NIH -National Heart, Lung and Blood Institute. Living with Cystic Fibrosis
Retrieved on July 14, 2014, from http://www.nhlbi.nih.gov/health/health-topics/
topics/cf/livingwith.html

13

De La Rochebrochard, E., McElreavey, K., & Thonneau, P. (2003). Paternal age

over 40 years: The amber light in the reproductive life of men? J Andrology,
24(4): 459464.

14

Anderson, L., Lewis, S. E. M., & McClure, N. (1998). The effects of coital lubricants
on sperm motility in vitro. Human Reproduction, 13(12): 3351-3356.

15

Walsh, T. J., Croughan, M. et al. (2009). Increased risk of testicular germ cell
cancer among infertile men. Arch Intern Med, 169(4): 351-356.

a4234_ITK_Male_txt_In the KnowText 12/15/14 8:45 AM Page 16

16

Medline Plus. (2012). Undescended Testis. Retrieved on July 14, 2014, from
http://www.nlm.nih.gov/medlineplus/ency/article/000973.htm

17

Kobayashi, H., Nagao, K., Nakajima, K., (2012). Focus Issue on Male infertility.
Advances in Urology. Volume 2012, Article ID 823582, 6 pages

18

RESOLVE. ART/IVF, Retreived on July 10, 2014 http://www.resolve.org/

family-building-options/ivf-art.html

19

ReproductiveFacts.org, Infertility: An Overview, Retrieved on July 10, 2014

http://www.reproductivefacts.org/Booklet_Infertility_An_Overview/

20

The American Infertility Association. Psychological Factors in Male Infertility.

July 10, 2014, from http://www.theafa.org/article/
psychological-issues-in-male-factor-infertility/

21

ODonnell, E. (2007). Making room for men in infertility counseling. Sexuality,

Reproduction & Menopause, 5(3): 28-32. Retrieved April 1, 2009, from
http://mindingmatters.com/wp-content/uploads/2012/07/
making-room-for-men-in-IF-counseling.pdf

22

MayoClinic.com (2012). Stress Management. Retrieved on Aug. 5, 2013, from

http://www.mayoclinic.com/health/exercise-and-stress/SR00036