Infertility affects approximately 1 out of every 6 couples. An infertility diagnosis is given to a couple who are unable to conceive over the course of one year. When the problem lies with the male partner it is referred to as male infertility. Male infertility factors contribute to approximately 30% of all infertility cases, and male infertility alone accounts for approximately one-fifth of all infertility cases.
What causes male infertility?
There are four main causes of infertility in males:
- A hypothalamic or pituitary disorder (1-2%)
- Gonad disorder (30-40%)
- Sperm transport disorder (10-20%)
- Unknown causes (40-50%)
Much research remains to be performed on the topic of male infertility, as many cases still receive an “unknown cause” diagnosis. Male infertility usually occurs because of sperm that are abnormal, because of inadequate numbers of sperm, or problems with ejaculation.
Sperm can be considered abnormal for two possible reasons: unusually short life span of the sperm and/or low mobility.
Sperm abnormalities may be caused by one or more of the following:
- Inflammation of the testicles
- Swollen veins in the scrotum
- Abnormally developed testicles
Reasons for a low sperm count or lack of sperm include one or more of the following:
- A pre-existing genetic condition
- Use of alcohol, tobacco or other drugs
- Severe mumps infection after puberty
- Hernia repairs
- Hormone disorder
- Exposure to poisonous chemicals
- Exposure to radiation
- Blockage caused from a previous infection
- Wearing restrictive or tight underwear
- Injury to the groin area
Male infertility can also occur when there are problems with ejaculation.
Ejaculation problems may include any of the following:
- Premature ejaculation
- Retrograde ejaculation, which occurs when the semen is forced back into the bladder
- Erection dysfunctions
- Complications from radiation therapy or surgery
Other causes of male infertility can include:
How is male infertility diagnosed?
Potential male infertility will be assessed as part of a thorough physical examination. The examination will include a medical history regarding potential contributing factors.
Your healthcare provider may use one or more of the following tests to assess fertility:
- Semen analysis to determine the number and quality of sperm
- Blood test to check for infections or hormone problems. Hormone levels are just as important in male fertility as they are in female fertility
- Making a culture of fluid from the penis to check for infections
- Physical examination of the penis, scrotum and prostate
Semen analysis is the most important part of male fertility testing. Some men find it more comfortable to do semen analysis testing in the privacy of their own homes. In-home testing kits are available.
What are they looking for in the testing?
When semen analysis is done, your health care provider will be looking for some specific markers to access fertility.
Total amount or volume of semen - 2 milliliters is considered normal. A lower amount may indicate an issue with the seminal vesicles, blocked ducts or a prostate gland issue.
- Sperm count - 20 million to 300 million per milliliter is considered in the normal range for sperm counts. Below 10 million is considered “poor.”
- Morphology - the size and shape of the sperm affect the sperms ability to reach and fertilize an egg. 30% is considered a good amount of sperm that are shaped “normal.” And “strict” testing shows an even lower percentage as normal.
- Motility - movement and number of active cells. Movement is rated from 0-4, with score over 3 considered good. The amount of active cells is rated in percentages from 1-100%, with 50% considered the minimum.
How is male infertility treated?
Male infertility is most often treated by conventional methods that include one or more of the following:
- Taking medications to help increase sperm production
- Taking antibiotics to heal an infection
- Taking hormones to improve hormone imbalance
- Avoiding taking long hot showers, using hot tubs or saunas
- Wearing looser underwear such as boxer shorts versus jockey shorts
Sperm production may also improve by taking clinically proven supplements. Anything that increases the number of healthy sperm increases the chances of conception. Many health food stores and vitamin shops offer male fertility supplements. See Shop for male supplements.
Artificial insemination is an option if the man’s sperm count is low. In this procedure, sperm is collected through multiple ejaculations. They are then manually placed in the female’s uterus or fallopian tubes.
In vitro fertilization is another option that can be used to overcome male infertility factors. In this procedure, the sperm and egg are fertilized in a laboratory after which the fertilized egg is placed in the female’s uterus.
If tests show that there is no sperm production or that other related problems are present, donor sperm can be used to help facilitate conception. In this procedure, donor sperm are obtained from a sperm bank and placed inside the female’s uterus or fallopian tubes through artificial insemination.
Can male infertility be prevented?
There is usually nothing that can be done to prevent male infertility caused by genetic problems or illness. However, there are actions that men can take to decrease the possibility of infertility.
- Avoiding sexually transmitted diseases
- Avoiding illicit drugs
- Avoiding radiation when possible
- Avoiding exposure to toxic substances
- Avoiding heavy or frequent use of alcohol
- Observing good personal hygiene and health practices
- Avoiding long, hot baths, hot tubs or saunas
- Wearing loose-fitting underwear
Compiled using information from the following sources:
RESOLVE: The National Infertility Association, http://www.resolve.org
American Society for Reproductive Medicine (ASRM), http://www.asrm.org
World Health Organization (WHO), http://www.who.int