THE TRUTH ABOUT MALE INFERTILITY

The truth about male infertility

Many people assume infertility indicates a problem with the female reproductive system, but in actuality, men and women are affected by infertility at similar rates. Your doctor will carefully review all test and examination results to see if they indicate a male fertility problem.

There are many reasons why men may have trouble conceiving, including:

  • Problems with sperm concentration, motility, and shape
  • Existing medical conditions that affect sperm production or cause duct obstructions
  • Unable to swim or abnormal sperm that have trouble fertilizing a female egg

A range of options are available to treat these issues.

For some people, the reason for male infertility may be unclear—called unexplained infertility. In these cases, your doctor may recommend advanced fertility treatment with assisted reproductive technology (ART) procedures such as in-vitro fertilization.

WHAT MEN MAY HEAR FROM THEIR DOCTOR

Although only one sperm is needed to fertilize an egg, the enzymes from multiple sperm are needed to break down the egg’s protective barrier. For conception to take place, these sperm must be:

  • Highly concentrated

Normal sperm density ranges from 15 million to 200 million per milliliter of semen.

  • Moving well

A lashing tail helps sperm swim to the egg. This is called sperm motility.

  • Normally shaped

Head, neck area, and tail need to have the appropriate shape. Sperm cells are shaped like streamlined tadpoles.

Sperm that lack motility and proper shape may have difficulty fertilizing an egg. ART treatments can help fertilization take place.

For men with low or no sperm, surgical extraction of sperm from the reproductive tract may be a treatment option.

Reduced sperm production is one of the most common causes of male infertility. Conditions that may affect sperm production include:

  • Scrotal varicose veins (varicoceles)

These swollen, enlarged veins can increase the temperature of the testicles, impairing sperm production. Treatment includes surgery performed under general anesthesia: Through a small incision in the groin, your doctor will tie or clip the swollen vein, or block it and redirect the blood flow.

  • Genetic defects

If genetic information on a man’s Y chromosome is deleted, it can reduce the production of sperm. Men with this condition may be able to have sperm surgically extracted from part of the reproductive tract. Other men may need to consider using donor sperm to conceive.

  • Anti-sperm antibodies

Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders. They can cause sperm to clump together, prevent them from swimming, or mistake sperm cells for an infection and try to destroy them. Males with anti-sperm antibodies can use ART treatments in order to conceive.

  • Hormonal problems

Some men have conditions that affect the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH), preventing them from developing healthy sperm. Hormonal problems can usually be treated with medication.

In the male reproductive system, sperm travel through ducts called the epididymis and vas deferens. Occasionally these sperm ducts can become blocked, causing a man’s semen not to contain any sperm. Scarring or adhesions from previous infections are one reason this may occur.

Blockages may be treated with surgery. In other instances, sperm may be able to be surgically extracted from part of the reproductive tract.

8 OTHER CAUSES OF MALE INFERTILITY

Serious testicular trauma can affect sperm production. Damage from playing sports or an accident can rupture the vessels that supply blood to the testicles. Testicular torsion, or twisting of the testicles, can also injure the area.

How is it treated?

Previous injuries can’t be treated. If the damage is severe, assisted reproductive technology (ART) treatments may be needed to help you conceive.

Before a baby boy is born, his testicles usually descend into the scrotum. Occasionally they descend after birth, usually within the first 6 months of life. If one or both testicles don’t descend and are left untreated, it can affect fertility.

How is it treated?

Surgery is not always recommended if an undescended testicle is found in an adult. Some men may need to use donor sperm in order to conceive.

Undescended Testicals

In men who’ve had mumps after puberty, swelling of the testicles may have occurred. This could have damaged sperm-producing cells in the testicles.

How is this treated?

Because usually only one testicle is affected, treatment may not be needed. But for some men, a sperm donor might be necessary in order to conceive.

A range of lifestyle factors can affect sperm production, including smoking, drinking, drugs, stress, weight gain, and poor nutrition.

How is this treated?

Making lifestyle changes can improve male fertility. Men should quit unhealthy habits, improve diet, and reduce stress.

Environmental factors like overheated testicles and some sexual lubricants can play a role in sperm quality. Heavy metal exposure, radiation, and industrial chemicals involved in certain manufacturing, painting, and printing jobs may also affect fertility.

How is this treated?

Steps should be taken to reduce exposure to harmful toxins and chemicals. Men can also wear loose clothing and keep heated electronics away from the lap to reduce the risk of overheating the testicles.

A man who has had a vasectomy has had his vas deferens, the tubes that carry sperm out of the testicles, cut. This prevents him from getting a woman pregnant.

How is this treated?

Vasectomy can be reversed using surgery. Your doctor will try to repair the section that was removed during the vasectomy. It can take a year or more for fertility to return.

The success of the reversal procedure can depend on how long ago the vasectomy was performed. If it was carried out more than ten years ago, there’s less of a chance of sperm reappearing in the semen.

Similar to female fertility, sperm quality deteriorates with age. Males over 40 have been shown to experience more fertility problems. 

How is it treated?

Your doctor will create a treatment plan based on results from testing and examinations.

Some types of cancer can affect the quality of semen. Testicular cancer may cause poor fertility before it is discovered, but semen quality usually improves a few years after treatment is complete. Hodgkin’s disease, lymphoma, and leukemia can also cause fertility challenges.

Cancer therapies like surgery, medication, radiotherapy, or chemotherapy may also damage sperm production. 

How is it treated?

Although fertility may eventually improve, it’s not a bad idea to talk to your doctor about sperm preservation before beginning cancer treatment. Donor sperm may also be a good option for some people.

MALE INFERTILITY TREATMENTS, EXPLAINED

Fortunately, many causes of male infertility can be addressed through medicine, surgery, and fertility treatment options, bringing men one step closer to fatherhood. Treatments include:

  • Surgery

Using surgery, doctors can fix blockages or function, repair varicose veins, reverse vasectomies, or retrieve sperm from other parts of the male reproductive system. After the procedure, some men may still need additional fertility treatment in order to conceive.

  • Antibiotics

If there’s an infection in the reproductive system, treatments like antibiotics may be used, though fertility may not always be restored.

  • Assisted reproductive technology (ART)

In ART treatments like in-vitro fertilization, sperm is collected from ejaculation or surgical extraction before being introduced to an egg for conception.

  • Hormonal treatment

Though more common in women, hormonal treatments—including medicines and surgery—may be used in men with low testosterone, abnormal hormone levels, or unexplained infertility.

  • Surgical sperm extraction

Your doctor may recommend this if there is little or no sperm in the semen. Depending on the type of procedure, doctors extract individual sperm from fluid or tissue.

  • Vibrostimulation or electroejaculation

Encourages ejaculation via vibrations (vibrostimulation) or stimulation of the pelvic nerves in the rectum (electroejaculation)

IN THE KNOW: MALE FERTILITY

Everything you need to know about male fertility, from diagnosis to treatment.

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