Male Infertility

Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery.

What Happens Under Normal Conditions? 

The man’s body makes tiny cells called sperm. During sex, ejaculation normally delivers the sperm into the woman’s body. The sperm go into the female partner’s vagina. The sperm travel through her cervix into her uterus to her fallopian tubes. There, if a sperm and egg meet, fertilization happens.

What Causes Male Infertility?

These are the main causes of male infertility:

Sperm Disorders

The most common problems are with making and growing sperm. Sperm may:

  • not grow fully
  • be oddly shaped
  • not move the right way
  • be made in very low numbers (oligospermia)
  • not be made at all (azoospermia)

Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone problems (such as low testosterone).

Varicoceles

Varicoceles are swollen veins in the scrotum. They are more common in infertile men (40%). They harm sperm growth by blocking proper blood drainage.
Other Causes

  • Retrograde ejaculation
  • Immunologic infertility/antibodies
  • Obstruction
  • Hormones
  • ​Medications

How is Male Infertility Diagnosed?

History and Physical Exam 
Your physician will ask about childhood illnesses, current health problems, or medications that might harm sperm production. Also, the use of alcohol, tobacco, marijuana and other recreational drugs will be inquired.

The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor will look for varicoceles. They can be found easily with a physical exam.

Semen Analysis 
Semen is collected by having you masturbate into a sterile cup. The semen sample is studied. It can be checked for things that help or hurt conception (fertilization).

Transrectal Ultrasound 
A probe is placed in the rectum. It beams sound waves to the nearby ejaculatory ducts to see if they are poorly formed or blocked.

Testicular Biopsy
If a semen test shows a very low number of sperm or no sperm you may need a testicular biopsy. This test can be done in an operating room with general or local anesthesia. The biopsy serves 2 purposes. It helps find the cause of infertility. And it can collect sperm for use in assisted reproduction.

Hormonal Profile
This is to learn how well your testicles make sperm.

How is Male Infertility Treated?

Non-Surgical Treatment for Specific Male Infertility Conditions

Anejaculation 
Anejaculation is when there’s no semen. Drugs are often tried first, but possible other treatments include rectal probe electroejaculation and penile vibratory stimulation.

Hyperprolactinemia
Hyperprolactinemia is when the pituitary gland makes too much of the hormone prolactin. It’s a factor in infertility and erectile dysfunction. Treatment includes medication or surgery.

Hypogonadotropic Hypogonadism 
The testicles don’t make sperm due to poor stimulation by the pituitary hormones. The congenital form, known also as Kallmann’s syndrome, is caused by lower amounts of gonadotropinreleasing hormone (GnRH). Gonadotropin replacement therapy would be the next step.

Surgical Therapy for Male Infertility

Varicocele Treatments
Fixing these swollen veins helps sperm movement, numbers, and structure.

Microsurgical Vasovasostomy or Vasoepididymostomy 
Microsurgical methods to undo a vasectomy.

Transurethral Resection of the Ejaculatory Duct (TURED)
Ejaculatory duct blockage can be treated surgically.

Treatment for Unknown Causes of Male Infertility

  • Assisted reproductive techniques
  • Intrauterine insemination
  • In vitro fertilization
  • Intracytoplasmic sperm injection
  • Sperm retrieval
  • Testicular sperm extraction
  • Testicular fine needle aspiration

What Can I Expect after Treatment?

Male infertility can often be fixed with an outpatient procedure. These are done under general anesthesia or IV sedation. Semen should be tested about every 3 months for at least a year, or until pregnancy.

The chance for pregnancy after vasectomy reversal depends on many things. It mostly depends on the age and fertility of your female partner. The number of years between your vasectomy and reversal also affects success. The longer you wait, the less likely the reversal will be a success.

Frequently Asked Questions

What health problems can cause male infertility?
Many health problems–from kidney disease to testicular cancer–can result in male infertility.

Can cigarette smoke affect sperm?
Yes. causes sperm cells to be smaller and slower. It harms their DNA. Smoking can also affect the seminal fluid ejaculated with sperm.

Can using steroids for body building cause infertility?
Yes. Steroids taken by mouth or shot can cause your body to stop making the hormones needed to make sperm.

What’s the main thing I should know about male infertility?
Infertility is not your or your partner’s fault. The American Society of Reproductive Medicine (ASRM) estimates that in about a third of infertility cases it is due to the male. In men, few or no sperm is the biggest problem.

What are assisted reproductive techniques (ARTs)?
ARTs are high-tech methods to join sperm and egg when sex can’t do it. 

If I have obstructive azoospermia, when should my partner and I consider sperm retrieval with an assisted reproductive technique (ART) rather than surgery? 
Often, microsurgical correction removes the need for ART. However, if that is not successful, sperm can be removed from the testicle or epididymis and injected into the vagina using ICSI, even after surgery to fix the blockage.

If I have a varicocele, when should my partner and I consider an assisted reproductive technique (ART) rather than surgery? 
Varicocele repair should be preferred if you don’t have ideal semen but your partner is fertile. On the other hand, IVF, with or without ICSI, should be the first choice when there’s a special need for such methods to treat a woman’s infertility.

Are there risks with IVF/ICSI? 
Yes, some risks exist, mostly for women. Mild ovarian hyperstimulation occurs in up to 20 out of 100 women who have IVF. It is caused by the hormones used in IVF/ICSI. Most women with mild cases tolerate symptoms well. There is moderate hyperstimulation in 5 out of 100 women having IVF.

Multiple births are also possible with IVF/ICSI. In the United States, after IVF there is a 30% to 35% risk for twins and 5% to 10% for triplets or more.