Male Infertility

Male infertility is indicated when a man is unable to impregnate a fertile woman after a year of regular, unprotected sexual intercourse. In a couple having difficulty conceiving, the problem can be due to one partner or to both. Once the problem is identified, fertility treatments can overcome the cause of infertility, whether due to the male or female.

Though many people think that infertility in a couple is most likely due to a female issue, that is not the case. According to the American Society for Reproductive Medicine, about half of all cases of infertility involve an element of male infertility. Male infertility is solely responsible for 20-30 percent of infertility cases and is a contributing cause, along with a female factor, in another 20-30 percent of cases.

Normal male reproduction

Men produce sperm in their testicles, and it is stored and transported in a system controlled by hormones. During ejaculation, the sperm mixes with seminal fluids to form semen, which leaves the body through the penis. If the semen contains enough sperm of adequate quality, one of those sperm can then fertilize a female egg that may be present in the woman’s fallopian tubes, resulting in pregnancy.

Conditions must be just right, including hormone levels, genes and environmental conditions, for a man to impregnate a woman. When something goes wrong with any of the male reproductive system functions, male infertility may occur.

Causes of male infertility

Sperm production

Male infertility, sometimes called male-factor infertility, most often occurs due to problems with sperm production. A normal ejaculation contains roughly 20 million – 300 million sperm. For a sperm to be viable, it must have the right structure and shape (morphology) as well as good movement (motility).

Sperm basics and male infertility

Age and lifestyle factors

Men can develop problems later in life due to bad habits such as drug use and alcohol abuse. A man’s age may also result in infertility, or at least a decline in fertility.

While testosterone production does decline as men age, a link between age and male infertility has not been proven. Note: Testosterone therapy, which some men undertake to improve their sex drive, can result in male infertility. Men who wish to be fathers and are considering testosterone therapy should discuss it with their physician first.

Age & lifestyle factors causing male infertility

Genetic factors

For the most part, genetic factors relate to abnormalities in sperm quality and production. Sometimes structural problems that cause infertility are due to genetic issues. This can include being born without a vas deferens, the tube that carries sperm to the ejaculatory duct.

Genetic causes of male infertility

Medical issues

Medical issues and lifestyle factors may not cause male infertility, but their presence can increase a man’s risk of being infertile. Medical problems resulting in male infertility include:

  • Ejaculation issues, such as retrograde ejaculation when semen goes to the bladder rather than out the penis
  • Vasectomy
  • Erectile dysfunction (cannot sustain an erection through ejaculation)
  • Varicocele (swollen vein that drains the testicle)
  • Infection
  • Tumors
  • Undescended testicles
  • Structural defects in some part of the system
  • Previous surgeries
  • Radiation treatment
  • Medications
  • Hormone problems
  • Exposure to toxins.

Correcting male infertility

Establishing the correct diagnosis for male infertility is crucial in using the appropriate treatment. First, doctors will find out about the man’s medical and sexual-practice history. A semen sample will be collected via masturbation, and a lab will conduct a semen analysis. Other tests may be required.

Once the doctor diagnoses the cause of infertility, treatment can begin. Medications may be used to correct a hormonal imbalance or address some ejaculation problems. Surgery can correct some structural issues, such as varicocele, and can also reverse a vasectomy.

Other treatment options involve assisting sperm to get to the egg for fertilization. This can be done with artificial insemination, most likely intrauterine insemination (IUI). In vitro fertilization (IVF) may also be used, including intracytoplasmic sperm injection (ICSI).

Using a sperm donor is another option to overcome male infertility.

Diagnosis and treatment of male infertility