Samuel Pang, MD is Medical Director at the Reproductive Science Center of New England. The interview that follows was conducted by editors of the website "Love to Know".  

When should couples become concerned about their inability to conceive?

Pre-Existing Medical History

In couples where one or both of them have a known pre-existing medical history that may predispose them to infertility, they should consult an infertility specialist as soon as they decide that they would like to conceive (these pre-existing conditions include a history of sexually transmitted infection, pelvic inflammatory disease, an irregular menstrual cycles, or a man with undescended testicles).

No Medical History

In couples where there is no medical history to suggest that they may have infertility, they are able to have sexual intercourse normally on a regular basis, and the woman is younger than 35-years-old, they should attempt to conceive on their own for one year before seeking consultation with an infertility specialist.

Age Concerns

If the woman is 35-39, they should seek consultation with an infertility specialist if they have not conceived successfully on their own after trying for six months. If the woman is 40 or older, they should seek consultation with an infertility specialist if they have not conceived successfully on their own after trying for three months.

What are the most common treatable causes of male infertility?

Sperm Count

Most cases of male infertility involve either low sperm counts or low sperm motility. Mild abnormalities are usually treatable with intra-uterine insemination (IUI). More severe abnormalities usually require treatment with in-vitro fertilization (IVF), with or without intra-cytopasmic insemination.

Environmental Factors

Some cases of male infertility may be due to exposure to environmental toxins such as tobacco smoking, recreational drug abuse, or excessive alcohol consumption. These cases may improve when the man stops smoking, using recreational drugs, or drinking excessive alcohol.

Other Factors

Sperm production and function are adversely affected by excessive heat, so if the man uses hot tubs, Jaccuzis, saunas, or steam baths, discontinuation may also improve semen parameters. There are also situations where the man has a large varicocele, in which case surgery to remove the varicocele may improve sperm motility.

Hormone Deficiencies

Male infertility is very rarely caused by a hormone deficiency, in which case hormonal treatment may improve the sperm counts.

Does the type of underwear a man wears really make a difference?

Probably not, but this recommendation is based on the fact that exposure of the testicles to excessive heat is bad for spermatogenesis. So, extrapolating from that, tight briefs that hold the testicles close to the body is assumed to be "bad" compared with boxer shorts that allow the testicles to hang loose and stay cool. Some have even gone so far as to suggest ice packs to the testicles! Unfortunately, there is no good scientific evidence that these measures are helpful in improving a man's fertility potential.

What steps could a man take to increase his sperm count?

While there may be theoretical benefits to antioxidant nutritional supplements and there are numerous reports that have suggested the benefit of antioxidant treatment for male infertility, these benefits have not been scientifically proven due to the sparsity of properly conducted randomized, double-blinded, placebo-controlled studies. Most studies in the literature are not randomized, placebo-controlled, or double-blinded in design. Pregnancy, the most relevant outcome, is rarely reported. Until those studies are performed, the use of antioxidants for the treatment of male infertility should be considered empiric.

Are infertility and sexual performance related?

The vast majority of cases of male infertility have nothing whatsoever to do with sexual performance. However, there are a few specific instances of infertility that are related to sexual dysfunction:

Vaginismus

Some women have a condition known as vaginismus, which is an involuntary tightening of the entryway into her vagina, resulting in the inability to penetrate the vagina with the penis for sexual intercourse.

Erectile Dysfunction

If a man has erectile dysfunction to the extent that his penis is too flaccid to penetrate his female partner's vagina so that he is unable to ejaculate inside the vagina, this may be a cause for their infertility. Most cases of erectile dysfunction are currently easily treatable with phosphodiesterase-5 inhibitors such as Viagra, Cialis, or Levitra.

Premature Ejaculation

Some men have no difficulty achieving erections but experience premature ejaculation such that ejaculation of semen occurs outside the vagina before vaginal penetration is accomplished.

Anejaculation

Other men do not have difficulty achieving erections, but are unable to ejaculate inside the vagina despite prolonged sexual intercourse. This condition is known as anejaculation, and may be due to psychological reasons, medical reasons (eg. spinal cord injury), or due to side effects of some medications.

What can you tell us about yourself and your practice/research?

I am a subspecialty American Board of Obstetrics and Gynecology certified physician in reproductive endocrinology, obstetrics and gynecology. Before joining RSC in 1993, I was assistant professor of gynecology and obstetrics at Loma Linda University School of Medicine in California. I am a licentiate of the Medical Council of Canada, as well as a diplomate of the National Board of Medical Examiners in the United States and a Fellow of the Royal College of Surgeons (Canada). I am also a Fellow of the American College of Obstetricians & Gynecologists.

I have conducted research and been published in the areas of menopause, infertility, and andrology and have a special interest in the management of male infertility. As the medical director of the egg donation and gestational surrogacy program RSC, I also have a special interest in the management of third-party reproductive options.