Infertility: ‘Not just a female problem’


Special to The Miami Herald

The emotional pain and treatment challenges of women’s infertility are well known to many, courtesy of books, movies and social media that share heartbreaking stories of women, primarily in their late 30s and 40s, who struggle to conceive.

Although men’s infertility may seem to be more of an afterthought in the public consciousness, the problem is as prevalent as it is for women, experts say.

“We just don’t hear about it as much. It’s just as common as female infertility,” said Dr. Lawrence S. Hakim, chairman of the department of urology and head of the Section of Sexual Dysfunction at Cleveland Clinic Florida

“It’s certainly typically the same amount male and female and sometimes both, which is why when you’re evaluating couples, they both need to be evaluated at the same time,” Hakim said.

According to the National Institutes of Health, the problem can be traced to the woman about one-third of the time, while another one-third of the time, the problem can be traced to the man. The remainder of the time, the problem is linked to both the man and the woman. Two-thirds of couples treated are ultimately able to conceive.

Part of the issue today is that many women are waiting much later in life to have children, Hakim said.

“As women get older they’re going to see more problems trying to conceive. Men can father children later in life, certainly into their 40s and 50s. They don’t have the same fertility issues that women have at that age.”

Common causes of men’s infertility can be hormonal problems, injuries, illness, medications, or a previous vasectomy. Lifestyle issues like smoking and alcohol use may affect sperm production, but are secondary factors, Hakim said.

A common cause of infertility in men is varicocele, an enlargement of the veins in the scrotum that heats the testicles, affecting the number and shape of sperm.

“Up to 30 percent of all men have a varicocele,” Hakim said.

Varicocele can develop in adolescence, and may be discovered by a pediatrician. Because of the long-term effects that can lead to infertility, a pediatric surgeon or urologist may recommend a procedure to correct the problem, depending on the severity. The purpose of the surgery is to seal off the affected vein and route blood flow into normal veins.

“You see a lot of men today who have had a vasectomy at an earlier age, and have married a younger partner and want to have children,” Hakim said.

Advancements in treatment and surgical procedures have improved over the past 50 years, he said.

More recently, the public has been bombarded with advertisements for medications aimed at correcting low testosterone or low T. These popular medications affect fertility, he said.

“We see a lot of men on hormone therapy like testosterone therapy for low T that have an impact on their fertility that can be detrimental,” he said, “and that’s something we see more now than we did in the past. It can make them azoospermic [infertile].”

Men should talk with their doctors about medications if they are trying to conceive, he said.

Infertility can be a painful issue for both partners, Hakim said: “With infertility, it’s not just a female problem.”

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