DRHOOK- Infertility: It's not just a girl thing

the handsome doctor John Hong

I'm writing this article on Father's day, when men all over the country celebrate the joys of parenthood. But what happens when a man cannot have a baby?

Oh, I know a man doesn't get pregnant–- well, unless he's Thomas Beatie, a female-to-male transgender. I mean some men are unable to impregnate a woman. One of my favorite shows, Lost, had an infertile Korean character. However, the reproduction doctor lied to the couple and attributed their infertility to the woman. 

This episode of Lost was right on in many ways. I learned in medical school that before 1970, a man was never asked to give a semen sample to check the sperm count. Why? It was the woman's "responsibility" to be fertile, and God forbid a man to be "impotent."

One study indicates that 20 percent of infertility cases are due to male factors, 38 percent to female factors, 27 percent to both persons, and 15 percent unknown. So today, if the woman checks out okay, the man is asked to give a sample. 

I just saw a Stanley Tucci movie, A Modern Affair, and he makes a deposit into the sperm bank on a regular basis. I thought it was nice to show how respectful and decent the environment is for sperm donation because it can be embarrassing for a man– though maybe some men would prefer it to be seedy. In this movie, Tucci's character is able to deliver the goods while listening to a baseball game. Holy home run, Batman!

Sperm samples are important to evaluate. Not all sperm cells are Michael Phelps. Some don't swim well and so never make it to or into the egg. Some men have a low number of sperm cells or none at all. Genetic causes to environmental factors can be responsible for these issues.

If the plumbing from the testicles to the penis is defective, it's like a gun shooting blanks. The plumbing can be damaged from problems ranging from infections to trauma. Also, the testicles can be damaged from tumors or might be undescended. 

Hormonal imbalances can throw off the production of sperm. Obesity can lower testosterone levels, even in nature. If you think of it, who's more likely to reproduce: Simba in The Lion King or the Cowardly Lion in The Wizard of Oz?

Taking anabolic steroids might reduce sperm count to make a body-builder go from "We are here to pump you up," to "You aren't going to pump it out." 

Speaking of drugs, narcotics and other psychotropic drugs can reduce hormone levels to make the testicles go to sleep. 

Genetic defects can make it impossible to reproduce. Problems from autosomal and X-chromosome defects to Y-chromosomal microdeletions can mean a viable embryo just doesn't work out well. Men with Klinefelter's syndrome have an extra X chromosome (XXY, instead of just XY); they have small testes and no sperm. Also they tend to have arms as long as an albatross. Men with Kallmann's syndrome tend to have undescended testicles, lack a sense of smell, and may also suffer from color blindness and mid-line facial defects. 

The pituitary gland in the brain regulates the hormones for proper testicular function. So if a stroke or tumor messes this gland up, infertility can occur. 

The list of causes for male infertility is longer than my grocery list before a holiday dinner. A urologist and endocrinologist can usually figure out the issue. It's nothing to be embarrassed over. You don't have to squirm about your sperm.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.