August 15, 2023
Approximately 15 million couples are affected by infertility worldwide. For many, it is an intense struggle. In a recent podcast interview with the Society for Assisted Reproductive Technology, Dr. Ajay Nangia, MD, a nationally-recognized urologist who specializes in male infertility at The University of Kansas Health System, described the experience of navigating infertility as a rollercoaster with extreme ups and downs.
“Infertility for a young couple is like an older person getting cancer,” Dr. Nangia says. “It’s really a horrible diagnosis that gnaws into your soul.”
In the United States, you can be diagnosed with infertility after 1 year of trying to conceive naturally with your partner. However, that may be expedited if there are complicating factors like age, a previous vasectomy, prior chemotherapy treatment or a history of testicular trauma or cancer.
For all couples trying to get pregnant, Dr. Nangia says the most important thing is to understand the fundamentals.
“Over my 25 years in practice, I have discovered one important thing: people do not know about the birds and the bees,” he says.
Although there is a lot of information available online, and apps specifically to time menstrual cycles and intercourse, Dr. Nangia says couples would benefit from understanding the basics of the female cycle and learning how to optimize natural fertility. Specifically, he points to the guidelines from the American Society for Reproductive Medicine.
Ways to optimize fertility
There’s an old myth that frequent ejaculation decreases male fertility. That isn’t true. Generally, it’s best to have sex every 1-2 days when you’re trying to get pregnant. However, you want to avoid it becoming a stressful activity.
Some lubricants contain hydrochloric acid. It kills the sperm, so that’s not ideal to use while trying to conceive. Additionally, some lubricants can change pH, which is also an important element for conception. Talk with your doctor about any fertility-friendly lubricants or try to skip using one.
There are many ways to track fertility: using the calendar method, cervical mucus monitoring, ovulation detection devices and basal body temperature tracking. Every woman’s cycle and peak fertile window is a little different. Using more than 1 method may increase your likelihood to conceive.
Heat can reduce your sperm count. Fewer sperm decreases the likelihood of conception.
Dr. Nangia says this one doesn’t really matter. Choose comfortable underwear that isn’t too tight.
“If it hurts your brain, and you get a hangover, it’s probably hurting your testicles too,” says Dr. Nangia.
What’s normal for male fertility?
“I don’t like that word,” says Dr. Nangia. “No normal number exists for the male species. There is a range.”
He explains that normal semen counts are based on men who achieved pregnancy within a year. Additionally, there is a wide spread of sperm values for fertile men, but the range is narrowed down when identifying what is normal. Those values are:
- Volume of at least 1.5 milliliters
- Sperm count of 15 million per cubic centimeter
- 40% motility
- 4% normal forms
“However, a man could fall within those values but there could be a functional problem of the sperm,” says Dr. Nangia. “It really truly amazes me that anyone ever gets pregnant, to be honest. 1 in 70,000-700,000 sperm make it through the vagina/cervix and then to the fallopian tube. There, as I describe to couples, a sperm is like a blade of grass on a football field. The length of the fallopian tube is the length of the football field. The egg is the size of a football. Somehow, in all of that, the blade of grass finds the football. And it’s not a straight shot either. It’s a miracle.”
Do you need to get a semen analysis?
The short answer is probably, but it doesn’t tell the entire story.
“A man is not a semen analysis. Infertility is not a semen analysis. The important part is the history and the physical,” says Dr. Nangia.
He estimates that 80% of an infertility diagnosis is based on your history and 20% is the physical examination and laboratory testing.
Can a vasectomy be reversed?
Around 500,00-600,000 vasectomies are done in the US each year, and about 6% of men consider having it reversed.
Dr. Nangia said it can be reversed with a microsurgery that takes about 3.5-4 hours.
“It uses very thin nylon stitches, smaller than a human hair, and a very big microscope,” he says. “The reconnection is complicated, detailed and takes skill. It absolutely does work, but it has to be based on variables.”
Those variables include:
- How many years ago was the vasectomy performed?
- Has the patient been taking testosterone since the vasectomy? If so, that must be stopped.
- How old is the female partner?
- Are there any female infertility factors?
- Are there any other male infertility factors?
- How far back is the blockage in the testicle?
- Is there any significant scarring?
Working as partners
Dr. Nangia stressed that it’s important for the couple and their doctors to work together as a team.
“The one thing that we forget is that it’s not them and us. It’s not the male side or the female side. Urologists who specialize in reproduction work as a team with gynecology fertility specialists. The end product is the outcome for the couple,” he said.
Additionally, Dr. Nangia encouraged couples to approach infertility as a discovery process – not a blame game.
“Be positive and try to move your lives forward to have children,” he says.
Male infertility treatment
Learn whether you are at an increased risk of male infertility, how it is diagnosed and the many treatment options available for male infertility at The University of Kansas Health System.