What are the Most Common Treatable Causes of Male Infertility?

(The following is excerpted from the website LovetoKnow.com and an interview regarding male infertility with RSC New England Medical Director, Dr. Samuel Pang.)

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, Jacuzzis, 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 scarcity 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.