Read about male infertility and how it is diagnosed and treated.

Not being able to conceive can be stressful. However, if you and your partner are experiencing difficulty conceiving, you should know you are not alone. Approximately one out of every six couples experience infertility. The data suggests that men contribute to around 50% of infertility cases. Learn about the most common causes of this condition and how it is treated.

What is male infertility?

Infertility refers to the inability of a couple to conceive a child, despite having regular unprotected sexual intercourse for one year or more. This timeline may be shortened to six months if the female partner is over the age of 35 or there are known medical conditions that may impact fertility.

Male factor infertility, or male fertility issues that cause or contribute to a couple's inability to conceive, can result from multiple factors: low sperm production, illnesses, injuries, medical conditions, and lifestyle choices. While male infertility may seem overwhelming, advances in reproductive medicine and guidance from fertility specialists can help increase your chances of conceiving.

How common is male infertility?

Male fertility issues are more common than people typically assume. For example, a study by the University of Geneva (UNIGE) found that only 38% of men in Switzerland have sperm that meets the World Health Organization's standard for male fertility.

What are the causes of male infertility?

Making healthy sperm depends on several things, from biological processes to environmental influences. Male infertility may arise due to multiple factors, including sperm production (also called spermatogenesis), the quality and quantity of semen, and how well sexual organs are functioning.

Male infertility is usually due to one or more of the following factors:

Sperm Disorders

A sperm disorder may involve:

  • Sperm that does not grow fully or is oddly shaped (also known as poor sperm morphology)
  • Sperm that is not efficiently moving in a forward direction (non-progressive motility)
  • Sperm that is produced in deficient numbers (a low sperm count or oligospermia)
  • An absence of sperm in semen due to impaired sperm production or blockages in the male reproductive tract (azoospermia)

Varicoceles

Varicoceles are swollen veins in the scrotum. It is estimated that 15 to 20% of all adult males will have a varicocele at some point. The exact way varicoceles cause infertility is unknown, and many men with varicoceles do not experience infertility.

It has been suggested that varicoceles may impede sperm growth by obstructing proper blood flow. In addition, varicoceles may result from malfunctioning valves that control blood flow in the veins. This may lead to blood flowing in the wrong direction, back towards the scrotum from the abdomen. As a result, the testicles may become too warm for sperm production, leading to low sperm count.

Retrograde Ejaculation

Sometimes semen can enter the bladder instead of being expelled through the penis during ejaculation. So even though you can still have an erection and orgasm, you may have little or no semen when you ejaculate. This condition, called retrograde ejaculation, is caused by bladder muscles that don't contract during orgasm.

Signs that you may have retrograde ejaculation include urine appearing cloudy after ejaculation and a decreased amount of fluid or 'dry' ejaculation. It can be a side effect of surgery, nerve damage, or medications.

Blockage

The movement of sperm can be disrupted by blockages. One common blockage happens in the tubes called ejaculatory ducts, which are responsible for carrying sperm and semen from the vas deferens (a tube that carries sperm out of the testes) and seminal vesicles to the urethra during ejaculation.

These blockages may be caused by inflammation, improper development, sexually transmitted diseases, or surgeries, like a vasectomy.

Approximately 40% of men who have a complete absence of sperm in their semen (known as azoospermia) have blockages in the tubes that sperm travel through.

Hormonal Imbalances

Spermatogenesis is a process that creates sperm cells. It involves hormones and interactions between different parts of the body, such as the hypothalamus, pituitary gland, and testes. The pituitary gland produces hormones that instruct the testicles to create sperm and testosterone. Testosterone, which is mainly produced in the testes, regulates the production of sperm, male sexual development, and sexual functioning.

If hormone levels are deficient, or if you have hormone imbalances, the growth and development of sperm can be disrupted, causing infertility. Additionally, you may experience issues with libido and ejaculation.

Chromosomal Abnormalities

Chromosomal abnormalities include genetic material absent or unusually arranged at the chromosomal level. About 14% of men with azoospermia and 2% with oligospermia have chromosomal abnormalities.

Immunologic Infertility

At times, a man's immune system produces special proteins called antibodies that attack and hinder his sperm. These antibodies, known as antisperm antibodies, are usually created in response to an injury, surgery, or infection. However, they are not a common cause of male infertility.

Although the exact way in which antibodies decrease fertility is not entirely known, they are linked to lower sperm quality. Specifically, they can obstruct the sperm's ability to swim and reach the fallopian tube where an egg's fertilisation occurs.

Medication

Certain medications can change how sperm is made, how it works, and how it moves. These medications are often used to treat health problems, such as:

  • Genetic diseases (such as Klinefelter syndrome, myotonic dystrophy, and microdeletion)
  • Medical conditions (like diabetes, certain autoimmune disorders, cystic fibrosis, and certain infections). Some medical conditions you may inherit, like cystic fibrosis, can cause the vas deferens to be missing. This can lead to a situation where there is no sperm present in the semen.
  • Cancer treatments: Cancer treatments like radiation or chemotherapy can harm sperm production; in some cases, the damage can be significant.

Environment and Lifestyle

Your environment and habits can also affect your sperm quality and sperm count.

  • Being exposed to certain environmental elements excessively, like pesticides or chemicals, can negatively affect male fertility. Repeatedly being in hot environments like saunas or hot tubs can increase body temperature and potentially cause harm to sperm.
  • Some lifestyle choices, such as using substances like drugs, alcohol, or smoking or taking certain medications, can impact fertility. Some studies worldwide have linked diet, air pollution, stress, and even wearing briefs instead of boxers to a decrease in male fertility. However, the research is still a topic of debate.

There are additional reasons that can contribute to male infertility. These reasons include genetic disorders, undescended testicles, long-term illnesses like kidney failure, erectile dysfunction, health problems such as diabetes, infections like chlamydia, gonorrhoea, mumps, or HIV, as well as childhood infections like mumps.

What are the risk factors for male infertility?

Certain factors can increase the likelihood of male infertility. These include:

  • Obesity
  • Being 40 years of age or older
  • Exposure to environmental toxins (such as lead, calcium, pesticides, or mercury)
  • Being a frequent consumer of tobacco, marijuana, or alcohol
  • Exposure of the testicles to high temperatures (such as through frequent sauna or hot tub use or sitting for long periods)
  • Being exposed to testosterone (through injections,or topical gel)
  • Taking certain medications (such as Cyproterone, Flutamide, Aldactone, Casodex, or Cimetidine)
  • Having undescended testicle(s)
  • Having varicoceles

How is male infertility diagnosed?

Identifying the cause of infertility may require several tests. In some cases, however, the underlying cause remains unknown. The diagnostic process may involve the following:

  • A consultation and physical exam. After inquiring about any inherited medical conditions, existing health problems, or surgeries, your fertility specialist may examine the genital area. This review allows the specialist to understand your medical history and get a better picture of your condition.
  • Blood tests. Blood tests are typically done to evaluate hormone levels. An imbalance in hormones may point towards a condition that impacts fertility.  
  • Semen analysis. A semen analysis evaluates the quantity and quality of semen and sperm. The semen sample can be collected in various ways, such as by ejaculating into a container provided by the fertility clinic. Alternatively, some men prefer to provide a semen sample in another environment (such as at home) or manner (such as with a non-toxic condom during sexual intercourse). If the semen analysis shows a significantly low number of sperm or no sperm, a testicular biopsy may be necessary.

Specialists use several factors to determine the best fertility treatments, including test results, how long the couple has been trying to conceive, the age and overall health of both partners and the individual or couple's preferences.

How is male infertility treated?

While the inability to have a child can be a source of stress and frustration, various treatments can address male infertility. The treatments for male infertility have expanded and include the following:

  • Surgical procedures can be performed to address specific issues, such as repairing a blockage. In addition, a vasectomy can be reversed, and if there is a lack of sperm, techniques can be used to retrieve sperm from the testicles.
  • Antibiotics can heal infections that affect fertility, but they may not always be successful.
  • Hormone treatments can help regulate hormone levels and address problems related to how hormones function in the body.
  • Medications or counselling can help with sexual problems that impact fertility, such as premature ejaculation or erectile dysfunction.
  • Assisted reproductive technology (ART) includes different ways of collecting and retrieving sperm, such as ejaculation, surgery, or donation. The collected sperm is then used to fertilise the female reproductive system using procedures such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

Are there any lifestyle changes that can help with male infertility?

Yes, there are some things you can do to increase your chances of getting pregnant:

To increase the chances of getting pregnant with your partner, it can help to have sex during the fertile window.

Some commercial lubricants, lotions, and even saliva can harm the movement and function of sperm. It's best to ask your fertility specialist for recommendations on sperm-friendly lubricants.

To safeguard your overall well-being, avoiding habits that can harm your health is important. Reduce the alcohol you consume, quit smoking, and steer clear of drugs.

In addition, maintaining a healthy weight, ensuring you get enough sleep, engaging in regular exercise, and eating a nutritious and balanced diet can be beneficial for your overall health.

Alternative medicine

Although more research is needed on how supplements affect male fertility, some supplements have been suggested to improve sperm quality or count. However, talking to a fertility specialist before taking any supplements to address male infertility is essential. Their effectiveness is not well established, and some may negatively interact with other medications.

Support

Dealing with infertility can be difficult, as it involves uncertainty and unpredictability. It is not always resolved through effort and can be emotionally taxing for couples. Preparing for how to cope with the emotional impact can be helpful.

  • Set limits. Plan and agree with your partner on a specific number and financially and emotionally feasible procedures, and establish an absolute limit. When considering fertility treatments, keep in mind that they can be expensive.
  • Consider alternatives. It's a good idea to think about other options, such as adoption or using donor sperm or eggs, at the beginning of the process to reduce anxiety.
  • Talk about your feelings. Seeking support from counselling services or communities can help you manage the emotional distress of treatment.
  • Practice stress-reduction. Relaxation techniques, like yoga or meditation, can help manage stress.
  • Talk about it. Instead of keeping overwhelming emotions of guilt or anger inside, seek support and talk to others about how you feel. Communicate with your partner about your thoughts and feelings throughout the process, or consider getting a counsellor.
  • Stay in touch with loved ones. Talking to your partner, family, and friends can be helpful.

Takeaway

Male infertility is more common than you think and could be why you struggle to conceive. It can result from various factors, ranging from issues with sperm production and abnormalities in sperm function to blockages that hinder the transportation of sperm. It can also result from long-term health problems, lifestyle choices, and other factors.

Fortunately, there is a variety of treatments for this condition. The proper treatment for you will depend on many factors, including your age, the cause of infertility, and your preferences.

Our empathetic fertility experts are here to advise you and discuss your options. Secure your free consultation today.