Male Fertility FAQs

Male Fertility Questions and Answers

By Martin Bastuba, MD, FACS

Patients often ask Dr. Bastuba questions about male infertility. We have compiled a list of the most frequently asked questions and separated them into related categories. View our comprehensive guide to male infertility below:

• Understanding Male Infertility
• Semen Analysis
• Low Sperm Count
• Increase Sperm Count
• Sexual Intercourse and Conception
• Vasectomy Reversal
• Visiting MFS

Understanding Male Infertility

• What is the official definition of male infertility?

  Infertility as defined by the American Society of Reproductive Medicine (ASRM) is “A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” A newer concept suggests that fertility evaluation is appropriate for any couple who feel they need evaluation including but not limited to females over 36 years of age, males post chemotherapy status, etc.

  Male infertility refers to the inability to conceive a child with a known fertile female. Several factors can lead to male factor infertility such as low sperm production, non moving (non-motile) sperm, abnormal sperm and blockages that prevent sperm delivery to the semen. These conditions can result from illnesses, infections, chronic health problems, injuries and/or environmental factors, such as exposure to certain chemicals.

• What is erectile dysfunction / impotence?

  Erectile dysfunction, also known as impotence or male sexual dysfunction, is an inability to get an erection that is good enough to achieve intercourse in a satisfactory way for both partners. The severity of erectile dysfunction can vary from complete lack of erection, to a partial erection that is not enough to penetrate your partner or is lost soon after you penetrate. Although erectile dysfunction is typically more common among older men, it can occur at any age and often does.

• What is premature ejaculation?

  Ejaculation is defined as the ejection and release of seminal fluid (sperm and other fluids) during sexual stimulation in a male. Premature ejaculation happens when a man has an ejection of seminal fluid too soon during intercourse to satisfy his partner or himself. The condition is often associated with anxiety or too much stimulation, and is more common during the early stages of a relationship. Though premature ejaculation may resolve on its own, it sometimes requires medical therapy. Such therapy is usually quite successful when administered under exact guidance.

• Is erectile dysfunction / impotence a cause or symptom of male infertility?

  Erectile dysfunction can cause male infertility because it interrupts or prevents intercourse. In order to conceive a child, sperm must be delivered to your partner's egg during intercourse. Thus, problems that prevent or interrupt intercourse, cause the inability to deliver sperm to the egg and lead to infertility. Having erectile dysfunction does not mean you are infertile.

  It is typical for the male in couples trying to conceive to experience erectile dysfunction due to the rigors of ejaculation on a timed schedule and general anxiety. This is often resolved with an oral medication such as Viagra or Cialis.

• Is premature ejaculation a cause or symptom of male infertility?

  Premature ejaculation is another possible cause for male infertility. As with erectile dysfunction, premature ejaculation can prevent the delivery of sperm into the vagina and thus the egg. This is especially the case when premature ejaculation occurs before penetration. However, if premature ejaculation happens during penetration, it may be sufficient enough to deliver sperm to the egg and cause fertilization. If you experience premature ejaculation, it does not mean you are infertile. Severe premature ejaculation can be easily treated by collection of sperm ahead of time for freezing and storage. It can then be released into the women in a procedure known as IUI (intra-uterine insemination).

• Can I experience male factor infertility even if my sperm count is healthy?

  Yes, you can experience infertility even if you have a “normal” sperm count. Male factor infertility can be caused by low sperm mobility, malformed sperm, anti-sperm antibodies, poor sperm viability (forward progression) as well as blockages in the sperm ducts that prevent the sperm from entering the semen. Even though your sperm count maybe normal, these other factors can cause infertility and, of course, female fertility potential must also be taken into account.

• Does Viagra affect male fertility? Will Viagra increase or decrease sperm count?

  Viagra has not been proven to affect male fertility. There are no medical studies that show Viagra helps male fertility or has the ability to modify sperm count. Viagra can improve your ability to have and maintain an erection, which does help your ability to have intercourse. However, if you have been trying for more than 1 year with your partner to conceive without success, an appointment with your urologist is recommended to explore male factor infertility.

• What causes male infertility?

  Male infertility can be caused by a wide range of factors, including hormonal imbalances, congenital defects, injuries, infections of the reproductive system, obstructions, medication side effects, sexual dysfunction, or lifestyle factors (e.g., drugs, alcohol, tobacco, etc.). In many cases, these factors only temporarily impact male fertility, sperm quality, and the ability to conceive, but in some cases, the changes can be permanent. There also may be multiple factors at play that need to be addressed. Male infertility can be very complex, so it’s crucial that you schedule a consultation with a male fertility specialist if you’re experiencing difficulties conceiving.

• Can Masturbation cause male infertility?

  No, masturbation does not cause male infertility. However, it can temporarily reduce your sperm reserves, specifically if done multiple times a day.

• What are common male infertility symptoms?

  Many symptoms of male infertility are subtle or undetectable without a semen analysis, but the primary sign of infertility in men is simply the inability to conceive. There may also be other signs and symptoms, depending on the cause. For example, varicoceles (i.e., swollen veins in the scrotum) can cause a dull ache or a feeling of heaviness in the testicles. Hormonal imbalances can cause a wide range of symptoms, such as abnormal breast growth, decreased body or facial hair, low libido, and fatigue. Sexual dysfunctions can cause symptoms like erectile dysfunction, difficulty with ejaculation, or low-volume ejaculation. All of these symptoms can be potential signs of male infertility.

Semen Analysis

• Does a semen analysis hurt? How is this procedure performed?

  Semen analysis is a pain free procedure that measures the amount and quality of a man's ejaculate. In order to do the analysis, you'll need to provide a sample of your semen. This can be done by collecting a semen sample into a sterile container during masturbation, or by using a special condom that collects the sample during intercourse. Once you deliver the sample to your health care provider they will run the analysis in a laboratory.

• Is sexual intercourse or masturbation off-limits before a semen analysis?

  You should avoid ejaculation for two to five days before giving a specimen for a semen analysis. Sexual activity leads to ejaculation, which can lower your sperm count temporarily and affect the test results. On the day of the test, you need to collect the sample and then deliver it to the laboratory within one hour to obtain the most accurate results.

• Why are the results of my current semen analysis different from my original semen analysis?

  Men's ability to produce viable and healthy sperm can change considerably over days, weeks or years. This can be caused by several factors including aging, exposure to certain chemicals, infection and certain illnesses. Most often seminal parameters (the things we measure on a semen analysis) vary significantly without specific cause. There are also factors that can temporarily lower your sperm count, such as stress and thermal exposure. Thus, it is fairly common that your current semen analysis differs from one done a few years or even a few weeks back. Minor differences can also be accounted for due to varying techniques used in different laboratories. However having an analysis performed in one laboratory versus another, should not create a significant enough difference to affect the results of a normal vs. abnormal semen analysis. Male Fertility Specialists usually like to see at least 2 semen analysis to feel confident of the patient’s baseline status.

Low Sperm Count

• What is the sperm count for healthy semen?

  Normal sperm count or concentration as defined by WHO, 5th edition, 2010 includes a concentration of 15 million per milliliter of semen. In addition, at least 40 percent of the sperm should have normal motility. Shape is evaluated by looking at 300 sperm and judging them against a “perfect sperm shape”. This process called the Krueger Strict Morphology, is felt to be “normal” if 4% of the sperm meet this stringent criteria. However, these values can slightly vary depending on the laboratory that analyzes the semen sample.

• If I have a low sperm count, am I infertile?

  Low sperm count is one of the leading causes of male infertility. Although low sperm count may decrease you and your partner’s chances of conceiving a child through intercourse, it does not mean you cannot father a child. A useful way to look at things is a fertility quotient. Even if a male has decreased fertility, a female who is super fertile may still be able to get pregnant.

• What infertility treatments are recommended for low sperm count?

  The treatment options for low sperm count depend on the underlying causes for the condition. For example, if low sperm count is caused by swelling of the veins that drain testicles (varicocele), or blockage of the sperm ducts(ejaculatory duct obstruction), these can be treated with surgery. If the condition is caused by infection or hormonal imbalances, these can be treated with certain medications. In some cases, the low sperm count can't be treated and the only option for fertility is to use assisted reproductive technology (ART). This is done by taking the sperm directly from the testicle and then artificially injecting it into the egg. In vitro fertilization (IVF) is the most common ART treatment. This process, known as intracytoplasmic sperm injection (ICSI) is a form of in-vitro fertilization (IVF) and is the most common ART treatment.

• Can an STD cause low sperm count?

  Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, can cause low sperm count. These infections can interfere with sperm production and cause scarring that blocks the passage of the sperm. STDs can be treated with antibiotics, and treatment usually returns your sperm count to normal. Untreated STDs can lower your sperm count permanently by causing scarring and blockage of the sperm delivery tubes.

• Does alcohol lower sperm count?

  Yes, alcohol can lower sperm count. Excessive drinking can lower your testosterone levels and decrease sperm production, leading to low sperm count. Moderation of alcohol intake is always recommended.

  Click Here to Learn About Low Sperm Count & Treatments

Increase Sperm Count

• Can certain types of underwear increase or decrease my sperm count (boxers vs. briefs)?

  Though wearing tight underwear holds your testicles close to your body and what might seem to cause pressure and increases the temperature in your scrotum, there is NO proven impact on fertility in 2 well reported studies. Thus there is no recommendation about wearing boxers or briefs.

• Can regular exercise and a healthy diet increase my sperm count?

  Regular exercise helps maintain weight and reduce emotional stress. Both stress and being overweight can negatively affect sperm quality and count. Thus, managing your weight and stress level with healthy diet and exercise can have a positive effect on your sperm count. Obesity is known to impact the testosterone to estradiol ratio which can negatively affect male fertility

• Does masturbation increase or decrease my sperm count in any way?

  Masturbation will typically lead to ejaculation. Although this won't have any long term effects to your sperm quality or count, it does affect your sperm count temporarily. Every time you ejaculate you will lose sperm from your body. If you and your partner are trying to conceive, regular masturbating can lower your sperm count and make it more difficult to get pregnant. It is best to avoid masturbation during the period of time you and your partner are trying to conceive a child.

• Will avoiding extreme heat such as laptops in my lap and hot tubs help increase my sperm count?

  Hot tubs and heat emitting laptops can increase the temperature in your scrotum. Even a slight increase in temperature can have a negative effect on your sperm production. If you and your partner are trying to conceive, it is better to avoid hot tubs, sauna's and other heat sources, such as heating pads and laptops.

Sexual Intercourse and Conception

• Are some sexual positions more conducive to getting pregnant than others?

  There is no scientific evidence supporting a claim that some sexual positions are more likely to lead to conception. Some positions, such as missionary, may deliver the sperm closest to the cervix, but whether this increases your chances of getting pregnant is not well understood. Timing intercourse properly during ovulation is more important than the position when trying to get pregnant.

• How many times per week should we have sex to get pregnant?

  When it comes to getting pregnant, having intercourse more often is not necessarily going to increase your chances of conceiving. Women are fertile only about five days during their monthly cycle – just before and during ovulation. Having intercourse at other times during the monthly cycle will not lead to pregnancy. In addition, having sex several times per week can actually lower your sperm count and decrease your chances of getting pregnant. To increase your chances of getting pregnant, you should have sex 2 days before expected ovulation and then on the day of ovulation and then 2 days later. Limit sexual activity other times during this fertile time period. The rest of the month is yours to enjoy as you please.

• Can tracking ovulation help our chances of getting pregnant?

  Tracking your ovulation is essential when trying to get pregnant. Ovulation occurs when a women release a mature egg from the ovary to the fallopian tube, making it available for fertilization. The released egg is only viable for 12 to 24 hours after leaving the ovary, and fertilization must occur during this time period in order to achieve pregnancy. Unlike the egg, sperm can survive up to 3 days in the fallopian tubes, waiting for the egg to arrive. Tracking your ovulation will help you determine the best days during your monthly cycle to get pregnant. The best days to have intercourse are a few days following ovulation and on the day of ovulation and two days after ovulation.

Visiting MFS

• Do you have many international and/or out-of-town patients?

  Yes, Dr. Bastuba has many patients not only from San Diego, California, but throughout the world. Patients come from all over the United States, as well as locally throughout California, Arizona, Nevada and Mexico.

• What are some local attractions in San Diego, California?

  San Diego, California is a popular travel destination with dozens of attractions suitable for every age. One of the most popular travel attractions include the San Diego Zoo, SeaWorld Adventure Park, Legoland, and numerous beaches. View our list of local travel attractions.

• What hotels in the San Diego area do you recommend?

  View our list of recommended hotels, nearby airports and additional helpful travel information. If you need any assistance planning your trip to San Diego, please feel free to contact our travel concierge Christina at 619-286-3520. She can answer any questions you may have and help making your trip enjoyable.

• Can I see patient reviews and testimonials about Dr. Bastuba?

  Yes, there are plenty of testimonials and some patient videos about Dr. Bastuba.