Treatment for Male Infertility in Indianapolis, IN

Male Infertility

Infertility affects roughly 15% of couples trying to build their family. Defined as the inability to achieve
pregnancy after 12 months of unprotected intercourse, infertility can have contributing factors from
both the female and male partner.

Although most people tend to think of infertility as a female problem, research has shown that there can
be a contributing male factor up to 50% of the time. This reality means that half of couples struggling to
achieve pregnancy will have some contributing male factor! That’s why it’s so important that both the
female and male partner undergo a fertility evaluation if there are concerns.

Compared to the female fertility evaluation, checking a man’s fertility is usually simple and non-invasive.
There are 3 key tests that almost all men seeking to have their fertility checked must obtain:

1) At least 2 recent semen analyses (also known as sperm counts)
2) A lab draw to check hormone levels
3) A thorough history and non-invasive physical exam

Occasionally more tests are needed and these are collected on an as-needed basis. However, for most
men, these 3 key tests are all that are needed to assess their fertility potential. Once these have been
obtained, a treatment plan can be established. This treatment plan may involve lifestyle changes, the
use of medications, and sometimes minimally-invasive procedures for men that require them.
To learn more about the male fertility evaluation and how we grade a man’s fertility potential, please
watch the video below from our fellowship-trained expert, Dr. Alex Tatem.

Lifestyle Changes and Medication

Simple lifestyle choices can have a profound impact on a man’s fertility potential. Obesity, poor diet, and
lack of exercise have all been shown to contribute both to male infertility and low testosterone levels.
Other significant causes of male infertility include tobacco, alcohol, cannabis, and other drug use.

Male infertility has often been described as the ‘canary in the coal mine’ of Men’s Health. This means
that infertility may be the first symptom that men experience as the result of poor lifestyle choices long
before other problems appear like high blood pressure, heart disease, and diabetes. As a result, we
encourage all men who are seeking to improve their fertility to improve their lifestyle.

In addition to lifestyle changes, medication can often be beneficial to certain men seeking fertility
treatment. These medications are typically designed to optimize a man’s hormone levels.

Varicoceles

A varicocele is an enlargement of the veins that drain blood away from the testicle back up to the heart
and lungs. They are extremely common and can be found in about 15% of men. Varicoceles typically
develop during puberty and are the result the internal valves inside these veins failing. When these
valves work like they’re supposed to, they stop oxygen-poor from flowing ‘backwards’ away from the
heart. But when they fail, gravity pushes this blood ‘down’ and causes it to pool around the testicles inside the scrotum. This blood is hot and can then raise the temperature of the testicles. This elevation
in temperature can then cause problems for a select subset of men with varicoceles.

Although most men with varicoceles will not experience any problems related to them, the increase in
temperature caused by these dilated veins can have a significant impact on fertility in approximately 1 in
5 men found to have them. For these men, varicocele repair has been shown to significantly improve
fertility in approximately 60-70% of cases. When performed microscopically by a fellowship-trained
expert, varicocele repair is a safe, minimally-invasive, same-day procedure with very little discomfort.

What We Do When There’s No Sperm

A complete lack of sperm in the ejaculate, a condition known as azoospermia, is the most profound form
of male infertility. Typically, azoospermia is a result of one of three possibilities:

1) A plumbing problem

 Known as obstructive azoospermia (OA), a ‘plumbing problem’ means that the
testicles make sperm, but the tubes that carry them away from the testicle are
blocked. This issue could be caused by prior surgery (like an injury during hernia
repair) or it could be the result of a condition a man is born with.

2) A partial production problem

 Known as non-obstructive azoospermia (NOA), a ‘partial production’ problem
means that man may produce sperm, but it’s made in a small amount that it can
only be found inside the testicles themselves and not in the ejaculate. An example
of men who can have this version of NOA include men with Klinefelter’s syndrome.

3) A complete production problem

 Also known as non-obstructive azoospermia (NOA), a ‘complete production’
problem means that the man in question doesn’t make any sperm and never will.
Two very specific examples of this are men who possess AZFa and AZFb Y
chromosome microdeletions, known genetic causes of male infertility.

Distinguishing between these different types of azoospermia is a complex process that usually requires a
more thorough evaluation than the initial 3 key tests described above. Most men who don’t have sperm
in their ejaculate will benefit from special genetic testing in addition to the usual hormone checks we
perform for all men. It should be noted that there are some causes of azoospermia that don’t require
this sort of testing. Examples of these men include men who are currently taking, or have recently taken,
testosterone or other anabolic steroids and men who have previously undergone vasectomy.

To learn more about how we evaluate men who don’t have sperm in their ejaculate and the sperm
retrieval procedures we commonly perform, please see our educational video below from Dr. Alex
Tatem.

Collaboration With Female Fertility Experts

At The Men’s Health Center at Urology of Indiana, we believe that fertility treatment is a team sport.
This is true for both couples and their fertility treatment team. As we are exclusively dedicated to the

treatment of male infertility, we frequently collaborate with our female fertility colleagues to achieve
world-class results for our patients as they seek to build their families. To learn about the female fertility
specialists in our area, please see the handout at the bottom of this page. Please note that the female
fertility practices listed on this page all provide excellent care for our couples and are listed in no
particular order.

Male Infertility Patient Forms

Male Fertility Explained
Grading Male Fertility, ART, and Goals
Varicoceles
Azoospermia & Sperm Retrieval Procedures
Female Fertility Practices In Indianapolis