Male Infertility

Male Infertility | man in business suit

Male infertility at a glance

  • Male infertility is the inability of a man’s sperm to fertilize a woman’s egg, either due to issues with sperm function, number or movement.
  • Male infertility is the cause in about 20 percent of infertility cases and one of the factors in another 20 percent of infertility cases, according to the American Society for Reproductive Medicine.
  • Male infertility may be a symptom of other health problems, such as cystic fibrosis or diabetes.
  • The type of treatment depends on the underlying cause of male infertility, and can include surgery, medication or assisted reproductive technologies such as artificial insemination, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

What is male infertility?

Male infertility is the inability of a man’s sperm to reach and/or fertilize a woman’s egg. This can be caused by problems with the production, transportation or movement of the sperm.

Men are considered to be infertile if they:

  • Don’t produce sperm.
  • Don’t produce enough sperm.
  • Produce abnormal sperm that cannot survive to fertilization.

Male infertility extends to any issues with the sperm getting from the testes to the egg, including erectile dysfunction. Male infertility is the sole cause of infertility in approximately 20 percent of couples trying to conceive.

Male infertility is often a symptom of another disorder, such as sexual dysfunction, genetic abnormalities or such lifestyle factors as obesity. In rare cases, genetic disorders such as cystic fibrosis can also cause male infertility.

Male infertility can be reversed or treated as long as some sperm production exists and the sperm can be extracted to use in assisted reproduction. However, sterility (the absence of sperm or sperm production) cannot be treated.

Causes of male infertility

There are many possible causes of male infertility, which can be diagnosed by a reproductive endocrinologist, often working with a reproductive urologist.

  • Varicoceles: Abnormally swollen veins in the testicles that may disrupt testicular temperature regulation and can subsequently decrease sperm count and quality. This cause is controversial since many normally fertile men also have varicoceles.
  • Retrograde ejaculation: A disorder in which sperm go into the bladder instead of leaving through the penis during ejaculation. This can be caused by health issues such as diabetes and spinal injuries.
  • Undescended testicle: One or both testicles not dropping into the scrotum at or before childbirth, which causes the testicle(s) to not function properly.
  • Sperm morphology: Abnormal size and shape of sperm that can affect the ability of the sperm to get to the egg and sometimes can impair the actual fertilization.
  • Sperm motility: Poor sperm movement that can affect the ability to travel through the body to the egg and fertilize it.
  • Hormones: Disorders in the testes or other glands, such as the pituitary and thyroid, can cause an imbalance in testosterone or other hormones that are necessary for a man’s reproductive system to function properly.
  • Blockage: Damage or other obstruction in the passages from the testes or penis that blocks sperm from mixing with semen before ejaculation, or hinders semen from leaving the body. This can be due to a surgical vasectomy, an injury, a tumor or other possible issues.
  • Genes: Genetic disorders, such as cystic fibrosis or Klinefelter syndrome, can cause reproductive organs to develop abnormally, which can lead to low or absent sperm concentration.
  • Sexual dysfunction: Any issue with sexual function, such as erectile dysfunction, that hinders the release of sperm.
  • Psychological conditions: Emotional or mental issues or stress that can cause impotence or other sexual dysfunctions.
  • Other treatments: Aggressive cancer treatments, such as radiation or chemotherapy, and certain surgical procedures can damage the sperm or other parts of the man’s reproductive system. Patients who plan on having these types of treatments should consult a fertility specialist to determine if sperm freezing might be necessary to preserve fertility.
  • Unexplained (idiopathic): In most cases, the causes of poor sperm count, movement or appearance cannot be determined. In these cases, a so-called empiric approach can be used. This usually calls for use of either intrauterine insemination in milder cases or intracytoplasmic sperm injection (ICSI) in more severe cases or when more conservative treatments fail.

Additional risk factors for male infertility include tobacco use, excessive alcohol consumption, marijuana use, sexually transmitted infections (STIs), excessive exercise, and other lifestyle factors.

Symptoms of male infertility

The primary symptoms of male infertility are the inability to conceive and the absence of ejaculation. Most men do not experience any other symptoms. However, the root cause of the infertility can have other associated symptoms.

Some other symptoms that men report include problems with sexual function and desire. Men can also experience pain and abnormal growth in the testicles and breasts.

Male infertility testing

Testing for male infertility starts with an evaluation and physical exam. The evaluation examines the man’s medical history and lifestyle. The physician will go over any serious medical conditions or treatments, including STIs and trauma history, and will ask about tobacco, alcohol and drug use.

During the physical examination, the physician will look for any external physical problems that could cause infertility, such as varicoceles or undescended testicles.

After the physical test, other tests include semen analysis, blood tests and genetic screenings, where the physician can look at sperm quality and count, hormone levels and chromosomal abnormalities. The physician may order further tests if needed.

Male infertility treatment

The goal for male infertility treatments is to correct the underlying cause of the infertility in order to achieve pregnancy and have a healthy child.

Medications can help with hormonal issues, and surgeries can address structural problems such as a blockage or impotence. Additionally, some lifestyle treatments, such as weight loss or diet changes, can improve sperm quality and motility.

To overcome most issues with sperm quality, the fertility doctor will likely use assisted reproductive technologies (ART) such as intrauterine insemination (IUI), IVF or IVF with ICSI.