Author: Akash Kapadia, MD

Testing for Male Infertility

Depiction of sperm swimming in-front of blue background

Couples looking to conceive are often hypersensitive about their fertility. Many couples do not realize how long it can take to conceive – the general guidance for seeking fertility assistance is after about one year of trying. We’ve also learned much more about the causes of infertility over the past few decades, and we now know that male infertility accounts for about 50% of all cases. Before we get into testing, it is important to understand why males may be infertile. Ultimately, there are three overarching reasons:

  • First is a production problem. If the testes do not produce enough semen or sperm, they typically cannot reach the egg for fertilization.
  • Second, the shape (morphology) and movement (motility) of the sperm will also play a role, as these dysfunctional or deformed sperm cannot efficiently travel to the egg.
  • Finally, some men will also experience a blockage that prevents sperm from being ejaculated.

How We Test for Infertility

When couples suspect infertility, the next step is to see their respective sexual health specialists. For men, a urologist and men’s health specialist like Dr. Kapadia has the tools and diagnostic equipment to best assist. We take a stepwise approach toward understanding what issues, if any, may be preventing our patients from conceiving. These include:

When we first meet a male patient with infertility concerns, we perform a complete medical and lifestyle workup to understand more about potential contributory factors. We will discuss stress, diet, exercise, and other markers that may be impeding proper sexual health. The psychological component of infertility should not be overlooked, so we will discuss those concerns.

Semen analysis. As a first step, a semen analysis is required. This involves getting a sample and analyzing semen and the sperm contained therein. We will be looking at several markers, including the volume of semen produced, the amount of sperm within it, the ability of the sperm to move properly, known as motility, and the shape or morphology of the sperm. Semen analysis is very straightforward and performed in our office. However, we will take multiple semen samples over a few weeks as levels can change over time.

Hormonal analysis. Our body is regulated by chemicals produced in various areas of the body known as hormones. High or low hormone levels can cause infertility, so checking these levels through simple bodily fluid tests is a quick way to understand if there are any problems. Most commonly, we check on follicle-stimulating hormone (FSH) and testosterone. Other hormones may be checked as well.

Urinalysis. We may test patients’ urine for white blood cells, a sign of infection in the body, and test for sperm in the urine, known as retrograde ejaculation.

Ultrasound and X-ray. Using diagnostic imaging tools, we can check to see if there are blockages that would limit the flow of sperm into the semen,

Biopsy. In some cases, a biopsy of the testes, removing a small piece of tissue, may be appropriate to understand how sperm are produced and if there is a problem on the testicular level.

Can You Test at Home?

Most of the advanced diagnostic testing will be performed at your urologist’s office or a lab. However, there are home test kits to check for sperm count problems. These tests can be very accurate and relatively easy to use. However, low sperm counts should be confirmed and ultimately diagnosed by an appropriate specialist. Remember that the causes of infertility are many and varied, so using only one marker may not give a complete and accurate picture.

Is Male Infertility Getting More Prevalent?

The short answer to this question is yes. It seems that fertility rates are declining in men. This also appears to be happening in women. The most likely cause of this decline is endocrine disruption which involves hormonal or chemical imbalances. Research has been done on hormone-disrupting chemicals, many of which have been popularized by Dr. Shanna Swan. Public awareness of what is in our food and the products we use is starting to increase, but slowly. Chemicals in just about everything we consume, like BPA, phthalates, and PFAs, may all contribute to this fertility decline. Sadly, health regulatory agencies have not caught up to this potential threat.

Is It My Partner?

As mentioned above, about 50% of infertility cases are caused by a man, and a woman causes the other half. Breaking it down further, approximately 1/3 of cases can be attributed to the woman, 1/3 to the man, and the final third represents issues associated with both partners. We typically suggest that both partners visit their respective reproductive health specialists to get a complete picture of what may be causing infertility and receive appropriate treatment. Dr. Kapadia works with his female reproductive health counterparts to develop a comprehensive treatment plan if one or both partners have a fertility problem.

The Bottom Line

Infertility is becoming more prevalent in modern society because of several modifiable and non-modifiable factors. Speaking to a qualified men’s health specialist is truly the best way to understand more about infertility and possible treatments. However, patients should be aware that pregnancy does not often happen on the first or second try, so they should not jump to conclusions and do not need to visit a specialist for about a year without any luck. It is also crucial that partners keep an ovulation calendar, as this can dramatically improve the chances of conception. Lastly, a healthier lifestyle can improve the quality of sperm and the chances of getting pregnant sooner.

Related Topics:

Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective

Disclaimer: We want to address Tongkat Ali due to its recent and sudden rise in popularity, however, it is important to note that these studies are poorly designed and lack high-quality data. We can’t be sure of the benefits of Tongkat Ali until they are shown in well-designed clinical trials. Patients should consult with a physician regarding safety before starting any supplement regimen.

man dumping Tongkat Ali supplement from bottle into hand

Tongkat Ali or Longjack, an herb found in Southeast Asia and commonly used as part of traditional holistic medicine there, has risen in popularity due to claims about its effectiveness in increasing testosterone, reducing stress, and potentially even boosting male fertility. Various podcasters, including Joe Rogan and Professor of Neurobiology at Stanford University Andrew Huberman, have discussed this herb in depth. They posit that taking Tongkat Ali boosts antioxidant levels in the body to fight free radicals while normalizing certain hormones like testosterone and Cortisol. Do these claims hold water? Let’s dive in.

Before we evaluate each of these claims, it is important to note that the FDA does not oversee supplements. Therefore, you must do your due diligence about which supplements to buy, as their purity and concentrations can vary. Safety should be your primary concern. Continue reading “Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective”

Can “Forever Chemicals” Be Causing Male Infertility?

Several takeout containers including cups and bag lying across a counter

In the spirit of bringing you the latest research that affects male fertility, a Danish study¹ was recently published about the effects of forever chemicals and, in particular, PFAS or per and polyfluoroalkyl substances on sperm count and mobility. The study sought to understand how a mother’s exposure to these toxic chemicals during pregnancy could affect the child’s fertility later in life. Why does this matter? Testicular development in males occurs during the first trimester of pregnancy, and this is also a time when external endocrine disruptors can make a big difference. In this case, PFAS made up of thousands of different chemicals, accumulates in the human body and crosses the placental barrier into the child.

What This Study Showed

Approximately 860 men were evaluated. Their mothers provided blood samples during the first trimester of their pregnancy between 1996 and 2002. The study found that mothers with higher PFAS levels had children who were more likely to have a lower sperm count and mobility issues than adults.

Why This Study Matters

When we look at the increasing rates of male infertility, we know that there is no single cause. Instead, cases of infertility must be discussed and evaluated both from an individual and a societal level. It seems that exposure to these, amongst other environmental chemicals, may be partly to blame for some infertility cases. Most Americans have been exposed to and therefore retain PFAS in their blood – remember, once exposed, the body cannot remove these chemicals (hence the “forever” moniker).

Beyond infertility, these chemicals can also cause significant diseases later in life. Research suggests that these chemicals may cause metabolic disorders, including type-2 diabetes, high cholesterol, obesity, and more, all of which can also affect urinary health.

What’s the Prognosis?

Unfortunately, because of the ubiquitous nature of these chemicals, most pregnant mothers have been exposed to these toxic chemicals. Virtually every adult has been as well. Why? These chemicals are often used in food product packaging to improve their water and grease-resistant properties. The result is that many of your fast food and takeout containers have PFAS. Some of the most egregious packaging includes fast-food wrappers and boxes, popcorn bags, and pizza boxes.

How Can You Avoid These Chemicals?

Unfortunately, we do not yet have a regulatory structure identifying and regulating these chemicals. However, much like BPA and phthalates, consumers and food producers are taking note. Companies like Chick-fil-A, Chipotle, Whole Foods, and Burger King have alluded to or promised to remove these chemicals from their packaging. Of course, the time and cost to do so are such that we can expect to be exposed to these chemicals for many more years unless something is done from a public awareness or regulatory standpoint. For the time being, the fact that PFAS is not visible nor has acute effects (that we are aware of) often makes it a lower priority for many people. Regardless, working with a men’s health specialist like Dr. Kapadia is an essential first step to understanding the potential causes of infertility and developing a treatment plan to address it.

In the meantime, do your research to find out if any of the products you or your family members consume contain harmful chemicals. You may even wish to consider choosing products that specifically exclude these chemicals from their packaging. Even though it’s likely that we have all been exposed to PFAS already, reducing our future exposure can only be beneficial. Be your own health advocate by ensuring that what you eat and drink is not tainted by harmful chemicals.


  1. Petersen KU, Hærvig KK, Flachs EM, Bonde JP, Lindh C, Hougaard KS, Toft G, Ramlau-Hansen CH, Tøttenborg SS. Per- and polyfluoroalkyl substances (PFAS) and male reproductive function in young adulthood; a cross-sectional study. Environ Res. 2022 Sep;212(Pt A):113157. doi: 10.1016/j.envres.2022.113157. Epub 2022 Mar 19. PMID: 35318009.

Dr. Kapadia to Join Georgia Urology

Dr.Kapadia behind green and white background with Kapadia logo and Georgia Urology logo

After several successful years at Wellstar Urology, where he has become one of the leading penile implant surgeons in Atlanta, amongst other distinctions, Dr. Kapadia is excited and proud to be joining Georgia Urology in November 2022. Georgia Urology is celebrating 50 years of helping patients in Atlanta with their varied urologic needs and is the largest urology practice in Georgia and one of the largest urology practices in the country.

Dr. Kapadia will continue to be a leader in male infertility and erectile dysfunction at Georgia Urology and will serve patients throughout Atlanta. Of course, our attention to patient needs and quality is paramount, and this change will enhance our ability to provide the care you’ve come to expect from our team.

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Can Your Partner Get Pregnant After a Vasectomy?

Early image of an ultrasound next to a positive pregnancy test

If you are researching a vasectomy, you probably already know it is the most effective and least invasive surgical procedure couples can pursue when they no longer wish to have children but want to continue their active sex life.

A vasectomy is straightforward. It is not uncommon, in fact, to hear that some urologists have performed the surgery on themselves. However, one point of concern is if there is any chance that they can get their partner pregnant after a vasectomy. Before we delve into why, the answer is yes, it’s possible but rare.

Continue reading “Can Your Partner Get Pregnant After a Vasectomy?”

Improve Blood Flow to Treat Erectile Dysfunction

Blood cells flow in vein

The function of a man’s erection revolves around blood, so it stands to reason that improving blood flow can work wonders to enhance sexual performance and reduce the risk of erectile dysfunction / ED. There are several other potential causes of erectile dysfunction, including medication and even psychological considerations, but those will be discussed separately. Most importantly, early detection and treatment are important. Many men, often out of embarrassment, wait months or even years as their sexual health declines before seeking treatment from a qualified urologist or men’s health specialist. Or they opt for supplements or generic medications without a complete picture of their sexual health. Ultimately, visiting a knowledgeable specialist and urologist like Dr. Kapadia is the best next step.

In the meantime, whether you are suffering from ED or not, here are some tips to improve blood flow and give yourself the best chance at a long and satisfying sex life.

Continue reading “Improve Blood Flow to Treat Erectile Dysfunction”

Do Supplements Work to Treat BPH?

Man holds a supplement hoping it will help with his BPH symptoms

When discussing Benign Prostatic Hyperplasia or BPH with patients concerned about their lower urinary tract symptoms, they often ask us about supplements and, most often, Saw Palmetto. If you have paid attention to media ads over the years, you’ve almost surely seen one or more for this supplement. Indeed, this supplement is touted as a natural and effective option for enlarged prostate.

Continue reading “Do Supplements Work to Treat BPH?”

How Much Does a Penile Implant Cost?

Medical form for health insurance submission for penile implant costs

Foremost in the minds of many men we treat is the cost of a penile implant. Indeed, price is one of the most significant barriers to correcting severe ED. This article will discuss how to navigate the financial aspects of getting a penile prosthesis. Of course, we encourage you to contact our office and speak to our patient navigators as you may find that a penile prosthesis is within reach.

Continue reading “How Much Does a Penile Implant Cost?”

Dr. Kapadia Named Coloplast Center of Excellence in Penile Implantation

Dr. Kapadia standing in operating room ready to help patients after being named a Coloplast Center of Excellence in Penile Implantation in Atlanta

All of us at Dr. Kapadia’s practice are excited to have been named a Coloplast Center of Excellence for penile implantation. This is a designation awarded to very few centers across the United States. Dr. Kapadia is one of the foremost implantation specialists in the southeast United States, now recognized with this new designation. Coloplast chooses its Centers of Excellence very carefully. Not only do COE men’s health specialists have to perform a significant number of penile implants, but they must also be leaders in the field, promoting the advancement of patient care, safety, and effectiveness in penile implantation. Further, Coloplast only offers its COE designation to physicians who are leaders in their respective urologic professional associations.

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ED as a Precursor to Cardiovascular Issues  

Problems with blood flow is a common reason for ED, meaning ED could be an indication of cardiovascular issues to come

New research into the causes and correlations between disease states is always exciting, mainly because we can use correlated issues to diagnose or prevent co-occurring disorders. One fascinating correlation is between erectile dysfunction and cardiovascular concerns. Interestingly, approximately 57% of atrial fibrillation patients, a common heart rhythm disorder, also experience ED. A potential reason for this includes poor blood flow that affects the penis. However, interestingly, new cases of ED were rare in patients with existing atrial fibrillation. This research shows that ED can be a precursor or indicator of future heart disease. Why? When the blood flow in the body is compromised, the penis is often affected earlier and more apparently than other bodily structures.

Continue reading “ED as a Precursor to Cardiovascular Issues  “

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