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The Initial Approach to Male Infertility

The Initial Approach to Male Infertility

40% of all Cases of Infertility are Caused by Male Factors

Almost half of all couples we see at the Texas Fertility Center have some significant degree of male factor as the cause of their infertility. In other words, there is an abnormality in the sperm that makes it less likely for pregnancy to occur.

Problems that can occur  with sperm are:

  • the sperm concentration (the number of sperm in the ejaculate)
  • the sperm motility (the percent of sperm that are alive and swimming)
  • the normal sperm morphology (the percent of sperm with a normal shape)

While many of these men are referred to us directly from a urologist or from their partner’s OB/GYN, most male infertility is totally unsuspected – we make the diagnosis only after performing a semen analysis.

What is a Semen Analysis?

A normal semen analysis should contain at least 20 million sperm/mL of semen. At least 50% of the sperm should be motile, and at least 30% should have a normal shape.

Sometimes 2 Semen specimen are needed.

The first thing we do if we get an abnormal semen analysis is ask the man to give us another specimen, so that we can make sure that the abnormality that we are seeing is real and not just the result of a random poor quality specimen. We also stress that there should be at least 48 hours of abstinence prior to collecting a specimen to limit the likelihood of a random poor specimen.

If the second semen analysis is again abnormal, we will draw hormone levels on the man and refer him to a urologist for evaluation to make sure that he does not have any medical or anatomical abnormality that could be causing the poor result.

Medical issues like the following could significantly affect sperm production or quality.

  • diabetes
  • high blood pressure
  • the use of a variety of medications

Anatomic issues that can affect sperm quaility that can be correct

  • varicocele (dilated veins in the scrotum)
  • a blockage in the tubule system
  • a mass in the testicle

While the urologic examination occasionally identifies the problem, often the exam is normal – eliminating an anatomic cause as the source of the difficulty.

The hormonal examination is also very important, as sperm production occurs in response to stimulation by hormones produced by the pituitary gland – a small gland located at the base of the brain. Just as in women, these hormones must be produced in the correct amount in order to produce optimal sperm quality. In men, follicle stimulating hormone (FSH) stimulates the testicles to produce sperm, while luteinizing hormone (LH) causes the testicles to make testosterone. Testosterone is critical for sperm production – either too little or too much can markedly reduce sperm production.

Stay tuned for the next segment of this blog series! For more information please visit

Tags: , , , , , , , | Category: Low Sperm Counts, Male Infertility, Semen Analysis, Texas Fertility Center


Kaylen Silverberg, M.D.

Originally from Dallas, Texas, he received his undergraduate degree from Vanderbilt and attended medical school at Baylor College of Medicine. He completed his Obstetrics & Gynecology residency at Vanderbilt University Medical Center and his infertility fellowship at the University of Texas Health Science Center in San Antonio. Dr. Silverberg is actively involved in infertility research and has published extensively in the infertility literature. He was recently honored by the American Fertility Association with the Family Building Award, and he is recognized annually by the Best Doctors in America. Dr. Silverberg. a fertility specialist, is board certified in both Obstetrics & Gynecology and Reproductive Endocrinology.