Male Infertility

Male infertility refers to a male's inability to get a female pregnant (get her to conceive) after a year of having sex regularly without using birth control.

Both males and females can have fertility problems.

What are the causes?

• Problems with sperm. Infertility can result if a male is:
  • Not producing enough sperm (low sperm count).
  • Not producing enough sperm of normal size and shape (poor sperm morphology).
  • Producing sperm that are not able to reach the egg (poor motility).
• Problems in a man's reproductive organs, such as:
  • Enlarged veins (varicoceles), cysts (spermatoceles), or tumors of the testicles.
  • Sexual dysfunction, including not being able to have an erection.
  • Injury to the testicles.
  • Having had a testicle that did not drop to its location in the scrotum (undescended testicle).
  • A birth defect, such as not having the tubes that carry sperm (vas deferens).
  • A lack of certain hormones.
• Certain medical conditions. These may include:
  • Diabetes.
  • Cancer and cancer treatments, such as chemotherapy or radiation.
  • Klinefelter syndrome. This is an inherited genetic disorder.
  • Thyroid problems, such as an underactive or overactive thyroid.
  • Cystic fibrosis.
  • Infections.
  • Sexually transmitted diseases.

Infertility can be linked to more than one cause. The cause of infertility in some men is not known. This is called unexplained infertility.

What increases the risk?

• Age. A male's fertility declines with age.
• Using products that contain nicotine or tobacco.
• Excessive alcohol use.
• Obesity.
• Emotional stress.
• Exposure of the testicles to heat, such as frequent use of a hot tub or sauna.
• Using drugs such as anabolic steroids, cocaine, and marijuana.
• Being exposed to environmental toxins, such as pesticides and lead.

What are the signs or symptoms?

The main sign of infertility in males is the inability to get a female to conceive.

How is this diagnosed?

• Semen analysis tests to check sperm count, morphology, and motility.
• Blood tests to check hormone levels.
• Ultrasound of the scrotum to check for a varicocele or problems with the testicles.
• Transrectal ultrasound to check the prostate gland and to look for problems with the tubes that transport the semen (seminal vesicles).
• Taking a small sample of tissue from inside a testicle to look at it under a microscope (biopsy).
• Blood tests to check for genetic abnormalities (genetic testing).

To be diagnosed with infertility, both partners will have a physical exam and tell their health care providers about their medical and sexual histories. Additional tests may be done.

How is this treated?

Treatment depends on the cause of infertility. Most cases of infertility in males are treated with medicine, surgery, or lifestyle changes.

• Taking medicines. Medicines may:
  • Correct hormone problems.
  • Treat other health conditions.
  • Treat infections.
  • Treat sexual dysfunction.
• Having surgery. You may have surgery to:
  • Remove blockages in the reproductive tract.
  • Correct other structural problems of the reproductive tract.
• Making lifestyle changes. These changes may include:
  • Reducing alcohol use or not drinking alcohol.
  • Stopping use of drugs such as anabolic steroids, cocaine, and marijuana.
  • Losing weight.
  • Stopping smoking.
  • Using stress reduction techniques.

If other treatments do not work, your health care provider may recommend assisted reproductive technology (ART). ART refers to all treatments and procedures that combine eggs and sperm outside the body to try to help a couple conceive. ART may be effective for infertility caused by sperm problems including low sperm count and low motility. Examples of ART include intrauterine insemination and in vitro fertilization.

Follow these instructions at home:

Lifestyle

• If you drink alcohol, limit how much you have to 0–2 drinks a day.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Make changes to your diet if needed to lose weight or maintain a healthy weight. Work with your health care provider and a dietitian to set a weight-loss goal that is healthy and reasonable for you.
• Practice stress reduction techniques that work well for you, such as regular physical activity, meditation, or deep breathing.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Seek support from a counselor or support group to talk about your concerns related to infertility. Couples counseling may be helpful for you and your partner.
• Keep all follow-up visits. This is important.

Contact a health care provider if you:

• Feel that stress is interfering with your life and relationships.
• Have side effects from treatments for infertility.

Summary

• Male infertility refers to a male's inability to get a female pregnant (get her to conceive) after a year of having sex regularly without using birth control.
• To be diagnosed with infertility, both partners will have a physical exam and tell their health care providers about their medical and sexual histories.
• Seek support from a counselor or support group to talk about your concerns related to infertility. Couples counseling may be helpful for you and your partner.