What Is Male Infertility?

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What Is Male Infertility?

Male infertility describes a reproductive issue that results in a male being unable to impregnate their fertile partner.

Studies indicate that approximately 15% of American heterosexual couples will encounter fertility issues when trying to conceive. Male infertility is a contributing factor to as many as half of all these cases and is solely responsible for an estimated 20% of cases.

“Male infertility is present in about 5 to 7% of the population, demonstrated when couples attempt to conceive,” says Peter N Schlegel, MD, FACS, a professor of urology and reproductive medicine at Weill Cornell Medicine in New York.

Causes of male infertility can range from illness, injury, or a blockage that results in the inability to make and produce healthy sperm. Certain lifestyle factors–such as smoking, drinking alcohol, or obesity–may contribute to male infertility. 

Symptoms

The symptoms of male infertility depend on the specific cause. In many cases, not being able to conceive is the first sign that there could be an underlying fertility issue. 

However, if the cause of male infertility is due to a surgical or medical condition or a hormonal imbalance, there are symptoms associated with this. These include:

  • Pain or swelling in the testicle or scrotum area 
  • Sexual dysfunction (such as difficulty getting and maintaining an erection, low libido, or not ejaculating)
  • Cloudy urine after sex
  • Inability to smell 
  • Reduced facial or body hair

Diagnosis

Infertility is usually defined by a period of 12 months or more of regular, unprotected sex not resulting in conception. At this point, a fertility specialist will likely complete a thorough physical evaluation to help identify any underlying issues that may affect a male’s ability to make and produce healthy sperm. 

This evaluation will include the analysis of a sperm sample. According to Dr. Schlegel, an abnormal semen analysis is the most common identifier of male infertility. The sperm analysis will establish the sperm concentration (how many sperm are present), the motility (how many are swimming), and the morphology (the shape of the sperm). Healthy, swimming sperm are crucial in order for conception to occur. 

The analysis will also identify if there are any functional abnormalities present, which describes any physiological problem that could hinder sexual intercourse or ejaculation, says Dr. Shlegel.

Causes

Conception is a delicate process that can be disrupted by a host of factors, such as injury, illness, or even certain lifestyle choices. While some causes of male infertility are reversible, others are not.

“Causes of male infertility can range from things that people are born with, so congenital abnormalities to different chromosomal issues, to things that can be acquired and can worsen over the course of a man’s lifetime, like testicular tumors, varicose veins, hormone deficiencies, [or] lifestyle-related problems,” explains Paul R Shin, MD, a board-certified urologist at Shady Grove Fertility, a fertility center with practices across the US.

Poor sperm quality is often cited as a contributing factor–if not the sole reason–behind male infertility. The cause of this might become apparent upon further medical evaluation, while other times it may remain unclear.

Here are some of the main causes of male infertility.

Varicoceles

The leading cause of male infertility is varicocele, which is the swelling of the veins that supply the testes. This is similar to how varicose veins become swollen due to an increase in blood pressure, This causes poor sperm quality, motility, and function. In many cases, they are treatable. 

Certain Medications

Some medications can impair your ability to produce healthy sperm or negatively affect sexual function. Anabolic steroids, taken to increase muscle mass, can disrupt your body's natural testosterone production, which is a crucial hormone for sperm production.

Studies also show that some medications taken to combat depression and anxiety can affect sexual function (including a lowered sex drive, erectile dysfunction, and delayed ejaculation). Other FDA-approved medications that can affect male fertility are certain antibiotics (Ketoconazole, specifically), as well as some medications to treat blood pressure or auto-immune disorders.

If you're seeing a fertility specialist, bring along any medication you are taking or have recently taken to your appointment, regardless of whether or not it is over-the-counter or prescribed.

Kallmann Syndrome

Kallmann Syndrome is a rare disorder that causes the delay, and sometimes prevents the completion, of puberty. A key characteristic of Kallmann Syndrome is an impaired sense of smell. It can affect both males and females but is more common among males. For males, other symptoms include undescended testicles and the inability to grow facial hair. Without hormonal treatment, people with this syndrome will be unable to conceive.

Low Testosterone Levels

Testosterone is a male sex hormone that is responsible for sperm production. Low testosterone levels can reduce sperm quantity and impair sexual function, including lowering your libido and causing erectile dysfunction. As such, low testosterone levels can signal difficulty with conception.

Age-Related Sperm Motility

While males can technically get someone pregnant at any age after puberty, male fertility does decline with age. Studies show that sperm quality, concentration, and motility are all affected by advanced paternal age, which is widely considered to be age 40 and over.

Environmental Toxins

Sperm levels are declining globally, along with sperm quality. While scientists debate the cause of this alarming trend, studies show that exposure to environmental toxins, such as pesticides, plasticizers (a substance found in most plastics), and radiation from electronic devices, can negatively impact male fertility. The toxins disrupt the delicate hormonal balance required for healthy sperm production.

Retrograde Ejaculation

For people with retrograde ejaculation, some or all of the semen released at the point of orgasm passes into the bladder instead of through the urethra and out of the tip of the penis. Cloudy urine after sex is a common symptom associated with this condition.

COVID-19

There is no evidence to suggest that vaccinations against COVID-19 can impair male or female fertility. However, scientists are exploring a link between male infertility and actually contracting the virus. A study published in Fertility and Sterility featured 120 Belgian men with a median age of 35. It found that 60% of participants had reduced sperm count and motility one month after testing positive for COVID-19—37% were still impacted two months later.

Exposure to High Temperatures

A study from 2018 found that infertility levels were high among male bakers due to the hot environment they work in. This supports evidence that anything that raises the temperature of the testicles can reduce the quality of sperm. Tight underwear, a laptop placed over the groin for long periods of time, an undetected varicocele, or even just frequent trips to the sauna or steam room can all drive the temperature of the testes up.

Illness, Infection, and Injury

Illness, infection, and injury can all affect a person's ability to produce healthy sperm. However, there is some evidence to suggest that a diagnosis of poor sperm quality is also sometimes an indication that there is another underlying health issue at play, such as undiagnosed celiac disease or diabetes.c

Even prior ailments can leave a lasting imprint on your fertility. If contracted after puberty, mumps, a viral infection, can lead to decreased testicle size. This can potentially lead to reproductive complications.

Scar tissue from a previous injury can lead to duct blockages, preventing sperm from being released, while severe testicular trauma—either due to a sports injury or car accident—can lead to infertility.

Stress

Studies show that psychological stress in males is associated with both poorer sperm quality and lower concentrations. When a person is stressed, they release steroid hormones called glucocorticoids which suppress testosterone levels. In addition to poor sperm quality, stress can also negatively affect sexual function.

Certain STDs

Chlamydia, one of the most common sexually transmitted diseases in the US, has been shown to reduce male fertility when undiagnosed. Approximately 50% of men with chlamydia don’t experience symptoms; until treated, the infection can cause significant sperm DNA damage.

Other sexually transmitted diseases, including human papillomavirus (HPV) and hepatitis B and C viruses, are also associated with poor sperm quality. Attending regular screening for sexually transmitted diseases can help avoid this.

Immunologic Infertility

Both males and females can suffer from immunologic infertility. In men, it is an auto-immune disease that prompts the production of anti-sperm antibodies (ASAs) against their own sperm. These antibodies hinder sperm count, motility, and viability.

Risk

Certain lifestyle factors can elevate the risk of male infertility. These include smoking, abusing alcohol and cannabis, smoking tobacco, and obesity.

Studies have long drawn correlations between males who have obesity with poor sperm quality. A study from Harvard University cited that males who had overweight were 11 times more likely to have a low sperm count (called oligozoospermia) and 39 times more likely to have azoospermia, a term to describe when there is no sperm present, compared to males who were within a healthy weight range.

A healthy weight looks different for every person. Talk to your healthcare provider if you have any questions regarding your weight.

Not only does paternal smoking reduce sperm concentration, quality, and motility, but studies have also found that it also reduces the success rate of IVF. So now is the time to consider quitting smoking, if you haven't already.

A 2021 study also highlighted how cannabis can significantly hinder healthy sperm production, with 43% of the 409 infertile men included in the study identifying as habitual cannabis users.

Alcohol consumption can also impact fertility. One study showed that even regularly consuming five units of alcohol or more per week was enough to have adverse effects on sperm quality while consuming 25 units or more saw significant changes in sperm quality and quantity.

Prevention

The male body is continuously producing sperm, and each "batch" takes approximately 74 days to mature. As such, sperm quality can improve in as little as three months' time with positive lifestyle changes, says Dr. Shin. "That means no smoking, getting some exercise, stress management, [and not] consuming alcohol, tobacco, and marijuana," he says. "All those factors are dose-dependent and can impact male fertility."

In addition to the above measures, Dr. Schlegel recommends repairing certain medical conditions, such as undescended testes, avoiding excessive heat, and taking note of other conditions that can adversely affect sperm production or quality. Experts also advice banking your sperm prior to any medical treatments (e.g., cancer therapy) that can adversely affect fertility.

Treatment

Receiving a diagnosis of male infertility can feel scary. However, depending on the cause of your infertility, there may be a treatment option available to you.

"Effective treatments are available for a wide variety of conditions and severity of male infertility, including for men previously thought to be sterile (i.e. men with no sperm in the ejaculate) through evaluation, specific treatment, or assisted reproductive treatment—or a combination thereof," says Dr. Schlegel.

The severity of the case, the fertility status of the partner, and the comfort level of the couple together dictate the planned course of treatment, explains Dr. Shin: "The goal with any treatment is to get the sperm as close to the egg as possible."

For mild to moderate cases of male infertility, your fertility specialist may suggest intrauterine insemination (IUI). "[This is] a low-tech treatment option with a sperm wash," says Dr. Shin. "The washing process separates debris from the healthy sperm, creating a concentrated semen sample."

If IUI is unsuccessful, in vitro fertilization (IVF) will likely be the recommended next step. "The benefit of IVF is that sperm have more available eggs to fertilize," Dr. Shin explains.

For moderate and severe cases of male infertility, IVF treatment with the addition of intracytoplasmic sperm injection (ICSI) might be suggested. "Instead of positioning the sperm close to the eggs in the petri dish, the embryologist actually selects a single sperm and injects it directly into the center of an egg," says Dr. Shin. "ICSI is an extremely effective technique for overcoming male infertility."

A Word From Verywell

For some couples, the journey towards parenthood can be complex. Regardless of whether the fertility issue lies with one partner or both, it is important to maneuver any hurdles together. If a year of regular and unprotected sex hasn’t resulted in conception, a fertility specialist will be able to offer further guidance and talk you through your options. 

Infertility is often associated with females. However, male infertility is also common (it is a contributing factor to as many as half of all fertility struggles in the US) and can be a diagnosis steeped in shame. Your fertility is not a representation of your masculinity.

The good news is that in many cases, male infertility is reversible, either through treatment or lifestyle changes. The first step to overcoming male infertility is to reach out to a healthcare provider who can help you determine the next steps.

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