RMANJ’s urologist Dr. James Hotaling is an international leader in the field of male infertility, helping men from around the world resolve their fertility issues.

He is passionate about educating men – and women – about male infertility, especially when his advice can help ease a man’s fertility journey.

So whether you’re struggling to become a first time dad or just looking for more information about male infertility, you’ve come to the right place.


How common is male infertility?

Common. Of all the couples that struggle with infertility (about 1 in 8 couples), half the time there is a male issue involved.


What is male infertility?

Male infertility is defined as an abnormal sperm count and/or lack of pregnancy after one year of trying. Usually, that inability boils down to a problem with the sperm count, motility or morphology. In addition to the number of sperm a man has, the shape and movement of the sperm (or how well the sperm swims) is also important. A problem in one of these three areas can cause male infertility.

normal sperm count

What is a normal sperm count?

Sperm are tiny, and a sperm sample should contain millions of sperm. Because of this, sperm is measured in ‘concentrations.’ Normal sperm concentration come in a wide range, but 15 million sperm per milliliter is a good benchmark.


What about sperm motility?

While a high sperm count is good, a high ‘swimming’ sperm count is also important. In general, about a quarter of the sperm will swim – so if you have a 50 million strong sperm count, you’ll have about 12.5 million swimming sperm, and it’s the swimming sperm that drive your chances of achieving a pregnancy.


Do you treat patients that have zero sperm count?

I treat patients who have a low sperm count and low sperm motility, but there is only one per cent of the population that has absolutely no sperm, so that’s very rare.  For these patients, we can often do surgical procedures to obtain sperm that can be used for in vitro fertilization (IVF).

semen analysis

What are the causes of these sperm issues that define male infertility?

One of the most common causes of infertility are dilated blood vessels around the testicle. This condition is called varicocele and results from abnormal closure of the valves in these vessels, leading to pooling of blood around the testicle. As a result, the temperature inside the testicle can change, compromising sperm production. Most men produce a thousand sperm a second, so when you are making that many sperm, anything that disrupts the process can be damaging. This condition is pretty common – 15 per cent of all men have it, and 40 per cent of men with infertility have it.

Another cause of infertility for men is abnormal testosterone. If a man is not making enough of his own testosterone, this can cause problems with sperm production. Alternatively, if a man takes testosterone injections, this can shut down sperm production as it interferes with the hormone pathways necessary to drive sperm production. Low testosterone levels can be treated with medication – such as Clomid –that can help a man augment his own testosterone production.

Other causes include:

  • obesity and poor overall health
  • certain medications, including hair loss medication
  • genetic conditions that prevent the sperm from coming out of the penis
  • genital infections that cause scarring
  • sexual dysfunction
  • environmental factors
  • unexplained fertility

What are the treatment options for all these causes?

  • The first step is always to have two semen analyses done as sperm counts can vary considerably between samples. In each sample, we’ll look at sperm count, motility and morphology.
  • Next is a blood test to check for hormone levels like testosterone.
  • Then we look into the patient’s history to determine if any environmental factors are the cause of infertility. For example, if a man is exposed to high numbers of chemicals at his job, he may have problems getting a woman pregnant.
  • Next, we’ll check for varicocele. If this condition is present and is affecting the man’s sperm, we can perform a simple out-patient surgical procedure to repair the dilated veins around the testicle using an operating microscope. Once complete, the surgery cures the problem in most men – the condition reappears in only one per cent of men after surgery.
  • If a man has a good sperm count but low motility, doctors can suggest an intrauterine insemination (IUI) procedure that places his sperm inside the woman’s uterus, bypassing the need for sperm to swim through her vagina and cervix.
  • If the sperm analysis determines the man has no sperm in his ejaculate, there is a surgical procedure available that can help extract sperm from the man’s reproductive system. During this procedure, men will undergo general anesthesia and doctors will look for and extract sperm from inside their testicles with a microscope.
  • In this case, once the sperm is extracted, it is joined with the egg through IVF.

How do men deal with infertility?

All men deal different with infertility, but in general, men tend to communicate less about their emotions than women. That said, they experience many of the same feelings as women struggling with infertility: fear, guilt, anxiety, sadness and a sense of failure.

How can women – and others – help men going through this?

The best way to support a man dealing with infertility is to talk about it – but on his own terms. Let him share the way he is most comfortable. Just letting him know you are there to listen is a great start.