Essentials
- Overview (jump to topic): Male infertility is a condition in which a man’s sperm cannot fertilize a woman’s egg during natural sexual intercourse for a variety of reasons.
- Male reproductive problems are the sole cause of infertility in about one-third of cases and a contributing factor in about another third.
- Causes of male infertility: These can be low sperm count or problems with sperm motility (movement), physical obstruction or other problems with sperm delivery, hormonal imbalance, or genetic conditions.
- Symptoms: Symptoms of male infertility are most often not apparent, except for lack of conception with a partner.
- Fertility testing for men can diagnose the underlying problems.
- Treatments for male infertility: Our doctors discuss treatment options with the man and his partner, which can include lifestyle modifications, antibiotics, outpatient surgery, medication, artificial insemination or in vitro fertilization (IVF), sometimes with intracytoplasmic sperm injection (ICSI).
What is male infertility?
Male infertility is a condition in which a man’s sperm are not able to reach or fertilize a woman’s egg during or after sexual intercourse. There are many reasons for male infertility, and they often go undetected until a man and his partner want to get pregnant, but are unable to.
A man’s testicles are responsible for making and storing sperm. During sexual intercourse, the sperm combine with seminal fluid and are ejaculated through the penis into the female reproductive tract. Under normal conditions, the sperm will “swim” through the woman’s cervix and uterus, then into her fallopian tubes where the egg is located after ovulation. This is where fertilization occurs to develop into a pregnancy.
Infertility occurs when issues in either the male or female reproductive systems (or both) prevent this process from happening. One-third of infertility cases stem from male reproductive issues alone. The National Institutes of Health reports that female reproductive issues count for another third, and both male and female infertility along with unexplained infertility factors account for the last third.
Causes of male infertility
The cause of male infertility usually stems from sperm disorders, obstruction or malfunction of sperm flow, hormones, chromosome defects, difficulties with sexual intercourse, structural issues or medication.
Sperm health
Issues with making sperm can start from birth or childhood such as contracting mumps or issues with testicle development. Hormone imbalances, infections, other medical issues, age and long-term illness can cause poor sperm health. Sperm development and health can also be affected by lifestyle issues like smoking, drinking alcohol and obesity.
The most common problems around poor sperm health and function include:
- Sperm don’t fully develop.
- Abnormal shape or size (sperm morphology).
- Not moving properly (sperm motility).
- Not enough sperm being produced (low sperm count, or oligospermia).
- No sperm being produced (azoospermia).
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Obstructions in the male reproductive system
A common cause of a man’s infertility is swollen veins in the scrotum, called a varicocele. Swollen veins block blood drainage from the scrotum, which harms sperm. Sometimes varicoceles force blood to flow back into the scrotum, which warms the testicles too much, thereby decreasing sperm production.
Other blockages in a man’s reproductive tract can be caused by
- Repeat infections.
- Surgery, such as vasectomy.
- Developmental defects from childhood.
When blockage occurs, sperm cannot combine with the seminal fluid or the semen can’t exit the penis during ejaculation.
Chromosome defects
Chromosomes carry the DNA molecules that make a person. Abnormalities in the shape or number of chromosomes can affect conception or cause genetic birth defects in a baby, such as Down syndrome or heart defects. A man can inherit chromosome disorders that cause infertility. These include cystic fibrosis, Klinefelter’s syndrome and Kallmann’s syndrome.
It is common today for male and female patients with infertility to undergo genetic testing prior to trying to conceive or any fertility treatments. Men may be candidates for preconception genetic counseling based on their family history that might include heart disease or sickle cell disease. Some conditions in the family line could be a cause for a man’s infertility or can lead to recurrent miscarriage, infant death or birth defects in a child.
We offer genetic screening for men and woman during new patient consultations. Based on the results of the initial gene mutation testing, we may recommend additional testing, including preimplantation genetic testing (PGT) during IVF.
Medications, low-T and steroids
Certain medications can alter sperm production, function and delivery. It’s worth asking our fertility specialists about whether certain medications for arthritis, depression, infections, ulcers, psoriasis, high blood pressure and cancer could affect fertility.
Ironically, men who are treated for low-T (low testosterone) with hormone replacement therapy may experience reduced or halted sperm production. In effect, low-T treatments serve as a kind of male birth control. Long-term use of testosterone replacement may even cause sterility.
The use of anabolic-androgenic steroids, derivatives of testosterone often used to build strength and muscle mass, has proven to cause infertility in men, as well. Abuse of these steroids is linked to low and no sperm count as well as abnormalities in sperm movement and shape.
Weight and lifestyle
A number of studies show that obesity contributes to male infertility. The extraneous fat on a man’s body produces a hormone that decreases sperm count, production and quality. In fact, the odds of infertility increase 10% for every 20 pounds that a man is overweight.
Obesity is just one lifestyle factor that affects male infertility. Smoking cigarettes, drinking alcohol, using recreational and illegal drugs, psychological or emotional stress, and caffeine consumption can all play a role.
Though not a lifestyle factor a man can change, advanced age can also contribute to a reduction in a man’s fertility.
Other causes of male infertility
Hormone imbalances.
Medical conditions like diabetes and cancer.
Erectile dysfunction.
And others.
Symptoms of male infertility
The primary sign of possible male infertility is the inability to conceive a child with a female partner naturally. For most men, there may not be any other obvious symptoms, and they will only know once they see a specialist for male fertility testing.
However, for men who have a known hormonal imbalance, inherited disorder, psychological conditions or a long-term illness, some symptoms may be evident, such as:
- Difficulty performing sexually, such as reduced sexual desire, difficulty maintaining an erection, difficulty ejaculating or only ejaculating small amounts of fluid.
- Swelling, pain or a lump around or in the testicles.
- Decreased facial or body hair.
- Recurrent respiratory infections or an inability to smell.
Finer Points
Who has a higher risk for male infertility?
Although symptoms of male infertility aren’t always present, a man may be able to determine if he is at a higher risk of male infertility if he has experienced any of the following:
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- Earlier or later than average puberty.
- Undescended testicles.
- Exposure of the genitals to frequent high temperatures (such as hot tubs, saunas or even a laptop on the lap).
- Past or current prostate inflammation or genital infections.
- Groin injury or twisting (torsion) of the testicles.
- Hernia repair.
Male fertility testing
The first step to treating male infertility is to diagnose the underlying causes. The Fertility Institute doctors begin standard male infertility tests by talking with a couple to review overall health and take a health history of each partner.
Which Male Infertility Tests Should I Expect to Take?
For men, the physician may conduct a physical exam during which any structural or physical obstructions can be discussed. The specialist will also ask about medications, sexual habits, exercise and diet.
Semen analysis infertility test
What to expect during a semen analysis
The most common fertility test for men is a semen analysis. This test uses an ejaculate sample to measure
- Sperm count.
- Sperm motility (movement).
- Morphology (size, shape).
- Quality (such as consistency, alkalinity or acidity).
- Volume.
- And signs of white blood cells, which could signal an infection or an abnormality.
Finer Points
Two factors that make a semen analysis accurate
- Temperature.
- Timing.
The closer the semen is to human body temperature and the sooner the semen analysis occurs, the more reliable the testing.
Other male infertility testing
Other types of testing that our fertility specialist may request include:
- Blood test.
- Urinalysis (urine test).
- Hormone evaluations.
- Genetic testing, including PGT during IVF.
- Imaging of the urinary and reproductive systems.
- Psychological assessment.
Did you know
The Fertility Institute of New Orleans is the only clinic on the North Shore that offers in-house semen analysis? We offer this service in our Mandeville location for patient convenience.
Male infertility treatments
Depending on the results of the male fertility tests, treatment may include medication, surgery or lifestyle changes the man can undertake himself. We will have a thorough discussion with the man or couple covering all treatment options, including their chances of success and any risks involved. The decision on treatment will be made together by the patient(s) and doctor.
Medication
Our providers may treat hormonal imbalances, infections and erectile dysfunction with medication.
Surgery
Blockages after vasectomies may require an outpatient surgical procedure to reconnect the vas deferens. When sperm is produced but is not in the ejaculate such as in congenital absence of the vas deferens, we can extract the sperm surgically to be used in assisted reproductive technologies (see below).
Fertility preservation (sperm or embryo freezing)
For men with chronic conditions or facing cancer treatment, it may behoove them to preserve their fertility via freezing sperm or creating (through reproductive assistance) and freezing embryos for future fertility options.
Lifestyle changes
Lifestyle changes can improve a man’s sperm health, his overall health and help reduce stress and anxiety that can affect his fertility. Losing weight and adopting a moderate exercise routine and healthy diet help both the body and mind to be in optimal shape for reproduction.
IUI, IVF and ICSI
If sperm count and quality are the prominent issues, then intrauterine insemination (IUI) or IVF may be the best fertility treatments for men.
For very severe male factor infertility other IVF-related options include employing intracytoplasmic sperm injection (ICSI), in which a healthy sperm is selected and injected directly into a female egg in the IVF lab for best chances of fertilization.
The female partner can also use donor sperm through IUI or IVF. This may be a good alternative option for pregnancy for men with very low-quality sperm that cannot fertilize an egg through assisted reproduction, or for men with genetic concerns they do not wish to pass on to the baby.