In years past, the perception has been that an inability to conceive was attributable to problems with the woman’s reproductive functionality. But researchers like Dr. Liberty Barnes at Cambridge University who recently published the book “Conceiving Masculinity: Male infertility, medicine, and identity,” contradict the idea that this is a women’s issue. Barnes says that of those millions of people trying without success to conceive a child, 30 percent are due female factors, 30 percent are male factors, 20 percent are a combination of male and female factors, and 20 percent of cases of infertility are simply unknown.
Barnes says infertility in men has many causes, from trauma to viruses, and numerous possible solutions, including everything from surgery to hormones.
What Are the Symptoms of Male Infertility?
Unlike female infertility (where irregular periods may hint at a problem), obvious symptoms are not common with male infertility.
The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.
Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:
- Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Recurrent respiratory infections
- Inability to smell
- Abnormal breast growth (gynecomastia)
- Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
- Having a lower than normal sperm count (fewer than 15 million sperm per millilitre of semen or a total sperm count of less than 39 million per ejaculate)
Risk factors for male infertility include obesity, age (over 40 — yes, men also have biological clocks), current or previous infection of an STD, smoking, or excessive drinking. Some medications may also impair fertility.
When to see a doctor
See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:
- Have erection or ejaculation problems, low sex drive, or other problems with sexual function
- Have pain, discomfort, a lump or swelling in the testicle area
- Have a history of testicle, prostate or sexual problems
- Have had groin, testicle, penis or scrotum surgery
Male fertility is a complex process. To get your partner pregnant, the following must occur:
- You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
- Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
- There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
- Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.
How Is Male Infertility Diagnosed?
Male infertility is usually diagnosed by a semen analysis. This relatively simple test involves the man providing a semen sample for a lab to evaluate. The lab uses this sample to measure the amount of semen and the number of sperm, and to evaluate sperm shape and movement.
Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
However, further testing may include:
- A general physical exam by a urologist
- Specialized semen analysis, including genetic testing of the sperm (looking for the presence of antibodies) and evaluation of immobile sperm (to see if they are dead or alive)
- Blood work to check hormone levels, usually of FSH and testosterone, but sometimes also LH, estradiol, or prolactin
- Genetic karyotyping – When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
- Scrotal ultrasound – This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
- Post-ejaculatory urinalysis (urine testing), to check for retrograde ejaculation
- Testicular biopsy
What Causes Male Infertility?
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
- Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
- Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm.
- Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
- Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
- Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
- Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
- Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
- Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development.
Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, or in the urethra.
- Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation or painful intercourse.
- Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
- Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.
Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:
- Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
- Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
- Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.
Health, lifestyle and other causes
Some other causes of male infertility include:
- Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
- Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
- Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke. Second hand smoke also may affect male fertility.
- Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
- Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
What Are the Options for Male Infertility Treatment?
Some causes of male infertility are treatable or correctable through surgery. Options for treatment may include:
- Treatment with antibiotics, in cases of infection
- Surgical correction, in order to remove a varicocele, reverse a vasectomy, or repair a duct obstruction
- Medications or fertility drugs to improve sperm production
- Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract (IUI), or used to perform in vitro fertilization or intracytoplasmic sperm injection
Coping with infertility can be difficult. It’s an issue of the unknown — you can’t predict how long it will last or what the outcome will be. Infertility isn’t necessarily solved with hard work. The emotional burden on a couple is considerable, and a couple need to present a united front in an attempt to overcome it.
- Diagnostic evaluation of the infertile male: A committee opinion. Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility. 2015;103:e18.
- Strauss JF, et al. Male infertility. In: Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. www.clinicalkey.com. Accessed June 16, 2015.
- Rachel Gurevich – All About Male Infertility Diagnosis, Causes, and Treatment