Understanding Male Infertility: Symptoms, Causes, and Treatments
Physical Health
Are you trying to have children but finding it difficult? Although not many people openly talk about it, infertility is a common issue. Nearly one out of ten men experience the condition.
Male infertility can have multiple causes. Your doctor can help you identify some of the reasons you may be struggling to conceive. Depending on the cause of your fertility issues, there are multiple available treatments that may help, including hormone therapy, medication, surgery, and assisted reproductive technology.
What Is Male Infertility?
Pregnancy doesn’t always happen right away. However, when a couple has unprotected sexual intercourse on a regular basis for at least a year and they don’t conceive a child, experts say that they are infertile.
If your partner is under the age of 35 and you have been trying to achieve pregnancy for a year or more, it may be time to talk to a doctor. If your partner is 35 or older, you may want to see a doctor after six months of trying.
Infertility is often not accompanied by any other signs other than being unable to conceive a child. However, in some cases male infertility exists alongside other symptoms that may point to an underlying health condition. These may include:
- Erectile dysfunction
- Low sex drive
- Problems with ejaculation
- Pain or swelling in the testicles
- Loss of smell
- Gynecomastia (growth of breast tissue)
- Loss of facial or body hair
- Frequent respiratory infections
If you have any of these signs or symptoms, talk to your doctor. They may help your doctor understand which tests to run to determine the cause of your infertility.
Potential Causes of Infertility
Infertility can be affected by health problems that affect either person within a couple. About 20% of infertility cases are solely caused by health issues that affect men, while 30-40% of cases result from conditions in both partners.
There are several steps involved in creating a pregnancy. Sperm is made by the testicles and released into the vagina during sexual intercourse. This process may be disrupted if the testicles can’t produce enough sperm, the sperm cells aren’t healthy, or if there are problems releasing the sperm.
Underlying causes of male infertility include a variety of medical disorders and medications. The cause of infertility is unclear for about half of men.
Conditions That Affect the Testicles
Several disorders can prevent the testicles from making enough sperm, or can make the sperm appear abnormal. These include:
- Varicocele, a condition that leads to enlarged veins in the testicle and is found in 40% of men with infertility
- Testicle injuries
- Diabetes
- Certain autoimmune disorders
- Infections such as tuberculosis, urinary tract infections (UTIs), sexually transmitted infections (STIs), or fungal infections
- Cystic fibrosis
Some medications and substances, including cancer treatments, alcohol, tobacco, cannabinoids, opioids, steroids, and illicit drugs, can also affect the function of the testicles. Additionally, exposure to chemicals like insecticides or pesticides may decrease sperm count.
Hormone Imbalances
The hypothalamus and pituitary glands make hormones such as prolactin that “tell” the testicles to make sperm. When these organs don’t work properly, hormone levels may become too high or too low and sperm counts may decrease.
Conditions that lead to hormone imbalances include Cushing syndrome, iron overload, head injuries, tumors, or genetic conditions like Prader Willi syndrome or congenital adrenal hyperplasia. Your hormone levels may also change if you undergo radiation treatments or take testosterone supplements.
Genetic Conditions
Disorders that are caused by genes passed down through families can also lead to infertility. These conditions include Klinefelter’s syndrome, Kallman syndrome, myotonic dystrophy, and Y-chromosome microdeletion.
Infertility Risk Factors in Men
Some men may be more likely to experience infertility than others. You are at greater risk for this condition if you:
- Are at least 40 years old
- Smoke cigarettes
- Drink heavily
- Use drugs, including marijuana or opioids
- Are overweight
- Use medications containing testosterone or similar substances in order to treat health conditions or build muscle
- Have used certain types of medications, such as diuretics (water pills) or ketoconazole (an antifungal medication)
How Are Male Infertility Issues Diagnosed?
If you are having problems with your fertility, your doctor may want to run several tests in order to diagnose or rule out different potential causes.
Your doctor will likely start with a basic physical examination, which may involve checking for problems such as swelling of the prostate (a gland located in the groin), a hernia, or a mass in the testicles. Your doctor may also ask you questions about potential related symptoms such as fevers, a low sex drive, or injuries to the groin.
It may also be a good idea to undergo hormone testing to measure the levels of hormones like testosterone, prolactin, or thyroid hormones that may be affecting your fertility. In some cases, your doctor may also recommend undergoing genetic testing or a testicular biopsy (removal of a small piece of testicle tissue for further examination).
A common part of diagnosing male infertility issues is semen analysis — testing to measure sperm health. Semen analysis involves measuring three key factors:
- Concentration — How many sperm cells are found within a certain amount of semen
- Motility — How well the sperm are able to move
- Morphology — Whether the sperm cells are shaped normally
Semen analysis may also look at other factors, such as how much semen is being produced and how many white blood cells are found in the semen. These results can all help point to possible causes of infertility.
Male Infertility Treatments
The fertility treatments that work best for you depend on the underlying causes of your infertility, your partner’s age, how long you have been infertile as a couple, and your personal preferences.
In some cases, infertile couples can still get pregnant without treatment. Pregnancies happen in about 23% of infertile couples within two years, and 33% after four years. However, making lifestyle changes, taking medications, or undergoing procedures may increase your chances of conceiving.
Lifestyle Changes
Whether or not you undergo other infertility treatments, building up or changing certain habits can improve your sexual health and may help relieve infertility problems. You may want to try:
- Quitting smoking cigarettes or using tobacco products
- Stopping using marijuana or other recreational drugs
- Reducing how often you drink alcohol, or quitting drinking altogether
- Avoiding coming into contact with chemicals like pesticides and heavy metals such as lead and mercury
- Getting more physical activity
- Eating a balanced diet that provides a wide range of nutrients
- Taking antioxidant supplements
- Maintaining a healthy weight (both obesity and low body weight may contribute to fertility problems)
- Wearing boxers rather than tight-fitting underwear
- Avoiding saunas, hot baths, or other things that may increase the temperature of the testicles
You may also want to ask your doctor about any other possible steps that might help improve your fertility. For example, certain medications that you are taking may have side effects that impact sexual health.
Hormone Therapy
Several different hormones produced by the body are important in the creation of new sperm cells. Taking medications that contain human hormones may help treat male infertility, although not all research agrees. Your doctor may recommend taking one or more hormones, such as:
- Human chorionic gonadotropin (hCG)
- Gonadotropin-releasing hormone (GnRH)
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Human menopausal gonadotropin (HMG), which is a combination of FSH and LH
Hormone treatments may work best for men experiencing infertility due to low hormone levels. It is less clear whether these therapies can boost fertility for men with normal hormone levels.
Medications for Infertility
Your doctor may also suggest using other medications that work in different ways to affect fertility:
- Dopamine agonists can help treat tumors on the pituitary gland that lead to hormone imbalances.
- Aromatase inhibitors increase levels of testosterone and reduce levels of estrogen in order to boost how much sperm the body makes.
- Selective estrogen receptor modulators (SERMs) restore healthy hormone levels that lead to optimal sperm production.
- Antibiotics can treat infections such as prostatitis that may be impacting fertility.
Surgery for Infertility
Surgical procedures can help heal certain anatomical problems. Some surgeries, such as fixing a varicocele, may help the body produce more sperm. Surgery may also help sperm be more effectively delivered during ejaculation. For example, some men may need surgery to reverse a vasectomy or heal a blocked vas deferens (the tube that carries sperm out of the testicles).
Other types of surgery allow doctors to collect sperm directly from the testicles to be used in assisted reproductive technology procedures. This may be useful for men who produce very few healthy sperm or have a problem that prevents sperm cells from reaching the semen.
Assisted Reproductive Technology (ART)
ART consists of several different types of procedures that can assist with overcoming infertility problems. In the U.S., about one out of 50 babies born each year were conceived with ART. Common types of ART include intrauterine insemination and in vitro fertilization.
Intrauterine insemination (IUI) involves collecting a sperm sample and placing it directly into the uterus with a narrow tube. Couples who use IUI may have as much as a one in five chance of becoming pregnant during each cycle, although success rates can vary. IUI may be a good option for men with:
- Low sperm counts
- Reduced sperm mobility
- Erectile dysfunction
- Retrograde ejaculation (a condition that results in sperm being delivered backward into the bladder instead of out of the body through the penis)
In vitro fertilization (IVF) is a common form of ART that involves fertilizing egg cells outside of the body and then implanting them into the uterus. It may be helpful for men who have low numbers of healthy sperm or in cases where the sperm is not able to be ejaculated out of the body. IVF involves a couple of steps:
- Ovarian stimulation — Medication is used in order to encourage the ovaries to produce multiple egg cells at a time.
- Egg retrieval — A needle is used to collect eggs from the ovaries with the help of ultrasound imaging, which helps the doctor visualize where to place the needle.
- Fertilization — Sperm cells from a semen sample are incubated with egg cells, or a single sperm cell is injected directly into an egg.
- Embryo transfer — Fertilized embryos are delivered into the uterus via a long, thin tube.
Other ART options involve using a third party to get pregnant. For example, you may want to consider sperm donation if you don’t produce sperm or don’t want to pass on genes that may lead to a genetic disease. If you choose this option, your partner may be able to get pregnant with IUI or IVF using a sperm sample from another man.
If your partner doesn’t produce healthy eggs or can’t carry a pregnancy, other third-party-assisted ART procedures may help. You can choose to get an egg donation, in which your doctor can collect donated eggs from another woman, combine them with your sperm, and implant embryos in your partner’s uterus. Additionally, you can get a surrogate, in which another woman carries and gives birth to a pregnancy conceived via IUI or IVF with cells from you and your partner or from donors.
If you are interested in trying any ART options, talk to your doctor or to a fertility specialist. Whether ART is successful depends on multiple factors. The CDC lists success rates for ART procedures for fertility clinics across the country, and offers a calculator that can help estimate how helpful IVF may be based on the characteristics of you and your partner.
Addressing Male Fertility Issues
There are a lot of factors that can affect your fertility. If you and your partner are struggling to get pregnant, your doctor or fertility specialist can help uncover possible problems and recommend treatments that might work best for the needs of you and your partner. Infertility is a common problem, and there are multiple options that may help.
