Male Infertility Overview | RSC New Jersey | photo of male in thought

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. Time and lifestyle have an impact on the parts that manufacture the new sperm cells. The result is more sperm are impaired from a DNA perspective, possibly putting a pregnancy at greater risk for miscarriage and children born with increased health risks.

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.

The factor of a man’s age in reproductive ability is of sufficient concern that the American Society for Reproductive Medicine now recommends sperm donors be men who are “ideally less than 40 years of age to minimize the potential hazards of aging.”

The impact of age may go beyond just fertility for men. Some evidence suggests that older men have greater chances of fathering offspring who are at higher risk for birth defects and developmental disorders.

Maintain a healthy diet

The cells in a man’s body do not properly function if the body lacks nutrients. For this reason, it is important for men to maintain well-balanced diets to ensure their bodies have the nutrients needed to function properly, which assists in the production of healthy sperm.

Avoid alcohol and drug abuse

Aside from contributing to overall poor health, drugs, steroids and alcohol can lower the number and quality of a man’s sperm. Steroids specifically can cause testicles to shrink, decreasing sperm production.

Control weight

When it comes to fertility, men who are overweight may struggle to produce sperm. Obesity can also lead to a decreased sex drive. It is important for men to maintain a healthy weight in comparison to their height (BMI). 

Do not use tobacco

Tobacco is proven to decrease sperm production, in addition to causing a number of other overall health concerns.

Avoid stress

Prolonged stress can interfere with the hormones needed to produce sperm. Sometimes infertility itself can lead to stress so it is important for men to find a healthy release from stress during the time in which they are trying to conceive. Yoga, meditation and exercise are great ways to relieve day-to-day anxiety.

Environmental exposure

Certain chemicals can create female hormone-like effects in the male body, which can lead to reduced sperm production. Pesticides, herbicides, insecticides and other chemicals may also affect the sperm’s ability to bind to an egg during fertilization.

Activities that cause increased scrotal temperature

In order for sperm to mature, they must be a couple of degrees below normal body temperature, which is why the testicles are in the scrotum located outside the main body. Spending excessive time in hot tubs, wearing tight underwear, holding a laptop directly on the lap and other activities that increase scrotal temperature can decrease sperm production.

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

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