I recently had the pleasure of hosting Dr. Josh Bitran on the podcast to talk candidly about male fertility and men’s health in the context of infertility and family building through surrogacy. Dr. Bitran is a urologist who focuses on men’s health and infertility. His evidence-based and approachable style made this an especially valuable discussion for intended parents, partners, and professionals alike.
Why Male Fertility Must Be Part of the Conversation
Too often, male factor infertility is an afterthought—clinically and culturally. Yet male factors contribute to a substantial percentage of infertility cases. In surrogacy and assisted reproduction, overlooking the male component can delay timelines, increase costs, and produce avoidable setbacks. From a legal perspective, I see the real-world implications when a case gets paused while sperm quality issues are identified late in the process. Incorporating male fertility screening early helps align medical, legal, and logistical steps so that embryo creation, surrogate matching, and contract milestones proceed smoothly.
How Male Infertility Is Evaluated
Dr. Bitran walked through the core elements of a male infertility workup, emphasizing that the process is systematic and fixable in many cases.
- Initial assessment: A thorough medical and reproductive history, medication review, sexual health screening, and targeted physical exam.
- Semen analysis: Baseline testing for concentration, motility, and morphology; often repeated to confirm findings due to natural variability.
- Hormonal evaluation: As indicated, assessing hormones that regulate sperm production.
- Imaging/genetic testing: Ordered when red flags suggest obstructive causes, varicocele, or genetic contributors.
- Lifestyle audit: Identifying modifiable factors that can materially impact outcomes.
He underscored common lifestyle drivers that impair sperm quality:
- Heat exposure (saunas, hot tubs, laptops on lap)
- Smoking, vaping, and recreational drugs
- Excessive alcohol
- Anabolic steroids and some supplements
- Poor sleep, untreated sleep apnea, high stress
- Obesity and sedentary habits
- Environmental toxins and certain occupational exposures
Potential treatments and interventions range from counseling on lifestyle optimization and targeted supplements, to medical therapy for hormonal issues, varicocele repair when indicated, and advanced reproductive techniques such as IUI/IVF with ICSI. Where sperm retrieval is necessary, surgical options can be coordinated to support embryo creation timelines.
Early Screening and Rapid Advancements
A key takeaway: Start male fertility screening early, ideally in parallel with any evaluation of the female partner or egg source. Early data informs realistic timelines, helps select the most efficient clinical pathway, and avoids legal/contracting delays. Dr. Bitran also highlighted encouraging advances in diagnostics, microsurgical techniques, and laboratory methods that are improving success rates for couples and individuals who previously had limited options.
Dr. Bitran’s Journey and Our Shared Mission
Dr. Bitran shared his path into men’s health and infertility. His patient-first approach aligns with my surrogacy practice: demystify the process, build the right interdisciplinary team, and make informed decisions at each step. We both see the best outcomes when intended parents are empowered with clear medical guidance and when the legal framework is synchronized with the clinical plan.
