Male infertility

Overview

Nearly 1 in 7 couples is infertile, which means they haven't been able to have a child after having sex often without protection for a year or longer. In up to half of these couples, male infertility is at least part of the reason.

Too few sperm, sperm that don't work well or blockages that keep sperm from going where they need to go can cause male infertility. Illnesses, injuries, long-term health conditions, lifestyle choices and other factors may be part of male infertility.

Not being able to have a child can cause you and your partner stress. But there are treatments for male infertility.

When to see a doctor

See a healthcare professional if you haven't been able to cause pregnancy after a year of regular sex without protection or after six months if your partner is older than 35.

Medical causes

Health issues and medical treatments that can affect male fertility include:

• Varicocele. A varicocele is a swelling of the veins that drain the testicles. It's the most common cause of male infertility that can be fixed. Experts don't know exactly how varicoceles cause infertility, but it may be linked to blood flow that isn't typical. Varicoceles lead to lower sperm quantity and quality.

• Infection. Some infections can affect sperm making or sperm health or cause scarring that keeps sperm from traveling. These include epididymitis, irritation and swelling of the coiled tube at the back of the testicle, called the epididymis. Infections also include orchitis, irritation and swelling of one or both testicles, and some sexually transmitted infections, including gonorrhea or HIV.

  Some infections can cause lifelong damage to the testicles. But most often they can still make sperm.

• Ejaculation issues. Retrograde ejaculation is when semen enters the bladder during climax instead of coming out the tip of the penis. Conditions that can cause retrograde ejaculation include diabetes, spinal injuries, medicines, and surgery of the bladder, prostate or urethra.
• Antibodies that attack sperm. Antibodies are immune system cells that see sperm as harmful. The antibodies try to get rid of the sperm.
• Tumors. Cancers and tumors that aren't cancer can affect the male reproductive organs directly. This may be through the glands that release hormones related to reproduction, such as the pituitary gland, or through causes that aren't known. Sometimes, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
• Testicles that don't come down from the belly. In some unborn males, one or both testicles fail to come down from the belly into the sac that holds the testicles, called the scrotum. This is likely to lower fertility.
• Hormone imbalances. Conditions of the testicles or conditions that affect other hormone systems can affect fertility. Other hormone systems include the hypothalamus, pituitary, thyroid and adrenal glands. There are a number of possible causes for low testosterone, called male hypogonadism, and other hormonal issues.

• Issues with the tubes that transport sperm. Many tubes carry sperm. They can be blocked due to damage from surgery, infections, injury or not forming right.

  Blockage can happen at any level. This includes within the testicle; in the coiled tube at the back of the testicle, called the epididymis; in a tube that carries semen from the testicles, called the vas deferens; near the ejaculatory ducts or in the tube that carries urine out of the body, called the urethra.

• Chromosome issues. Conditions passed through families, called inherited, can cause the male sex organs to not form well. One such condition is Klinefelter syndrome, in which a male is born with two X chromosomes instead of one and one Y chromosome. Another genetic syndrome linked with infertility is cystic fibrosis.
• Trouble having sex. These can include trouble getting or keeping an erection firm enough for sex, called erectile dysfunction (ED). Other issues include ejaculating too soon; painful sex; or a penis that isn't formed well. For instance, the opening of the urethra may be under the penis, called hypospadias. Mental and relationship issues also may be involved.
• Certain medicines. Some medicines can affect the making of sperm and lower male fertility. These include testosterone replacement therapy, anabolic steroids used long term, chemotherapy medicines, some ulcer medicines and some arthritis medicines.
• Surgeries. Certain surgeries may keep you from having sperm in your ejaculate. These include vasectomy, scrotal or testicular surgeries, prostate surgeries, and surgeries for testicular and rectal cancers, among others.

Health, lifestyle and other causes

Some other causes of male infertility include:

• Drug use. Anabolic steroids taken to build muscle can cause the testicles to shrink and lower the sperm count. Use of cocaine or marijuana may cut the number and quality of sperm for a time.
• Alcohol use. Drinking alcohol can lower testosterone levels, cause ED and lower sperm count. Liver disease caused by too much drinking also may lead to fertility issues.
• Tobacco smoking. Smoking may lower sperm count. Secondhand smoke also may affect male fertility.
• Body weight. Having obesity can harm fertility. It can affect the sperm and cause hormone changes that lower male fertility.

Complications

Complications of male infertility can include:

• Being stressed and having partner troubles linked to not being able to have a child.
• Needing costly and complex fertility treatments.
• Having a higher risk of cancer, including testicular cancer.

Diagnosis

Diagnosis of infertility often involves both partners. It might take some tests to find the cause of infertility. Sometimes, no cause is found.

Diagnosing male infertility issues most often involves:

• Physical exam and medical history. Besides looking at your genitals, your healthcare professional asks about any conditions that affect your family, long-term health conditions, injuries or surgeries that could affect fertility. Be ready to answer questions about your sex life, whether you've fathered children in the past, and about your puberty.

• Semen analysis. You can give a semen sample by masturbating and ejaculating into a special container at a medical office. Some people prefer using a special condom during sex at home to collect a sample.

  Your semen then goes to a lab to measure the number of sperm present and look for any issues with the sperms' shape, called morphology, and movement, called motility. The lab also checks your semen for signs of infection or other issues.

  Sperm counts often change from one sample to the next. So you may have several semen analysis tests done over time to make sure the results are correct. If your sperm analysis is typical, your healthcare professional may suggest testing your partner before you have any more tests.

Other tests can help find the cause of your infertility. These can include:

• Scrotal ultrasound. This test uses sound waves to make images inside your body. A scrotal ultrasound can show if there is a varicocele or other issues in the testicles or around them.
• Transrectal ultrasound. A healthcare professional puts a small, lubricated wand into the rectum to check your prostate and look for blockages of the tubes that carry semen.
• Hormone testing. Hormones that the pituitary gland, hypothalamus and testicles make are vital to fertility. Issues in other hormonal or organ systems also might be part of infertility. A blood test measures the level of testosterone and other hormones.
• Post-ejaculation urinalysis. Sperm in your urine can show that sperm are traveling backward into the bladder instead of out your penis during ejaculation. This is called retrograde ejaculation.
• Genetic tests. Changed genes can be a cause of very low sperm count. A blood test can show small changes in the Y chromosome. Genetic testing can diagnose conditions that were present at birth, called congenital, or passed through families, called inherited.
• Testicular biopsy. This test involves removing tissue samples from the testicle with a needle. If the results of the testicular biopsy show that you're making sperm as expected, you likely have a blockage or another issue with sperm getting to where it needs to go.

When treatment doesn't work

Rarely, there's no treatment for male fertility problems. For you to have a child, your healthcare professional might suggest that you and your partner think about using sperm from a donor or adopting a child.

Alternative medicine

Some studies show that the following herbs or supplements may help male fertility by improving sperm count or quality.

• Coenzyme Q10.
• Folic acid and zinc combined.
• L-carnitine.
• Selenium.
• Vitamin C.
• Vitamin E.

Talk with your healthcare professional before taking dietary supplements for male infertility. There's no good proof that they work, and some supplements may cause side effects or affect other medicines you take.

Planning for ups and downs

• Set limits. Fertility treatments can be costly and often insurance doesn't cover them. Decide as a couple how many and what kind of procedures you think you can handle. How much are you willing to spend? Talk about how you'll deal with the feelings the process brings up.
• Take a break. Sometimes it may help to stop treatment for a few months, then try again.
• Think about other choices. What else might you do? Use a donor sperm or egg? Adopt? Thinking about this early in the process may relieve some of the worry during treatments and help with loss of hope if treatments don't work.
• Talk about your feelings. Find support groups or counseling services for help before and after treatment. These may help you get through the process and help with grief if treatment fails.

Preparing for your appointment

You might start by seeing your main healthcare professional. If you have a known condition that causes infertility or have had tests that showed fertility issues, your healthcare professional may send you to a specialist.

Here's some information to help you get ready for your appointment.

Questions to ask your doctor

Basic questions to ask include:

• What might be causing my infertility?
• Other than the most likely cause, what are other possible reasons my partner and I haven't been able to have a child?
• What tests do I need?
• Will my partner also need tests?
• What treatments are there for my condition?
• Should I see a specialist?
• Are there brochures or fact sheets that I can have? What websites do you suggest?

Be sure to ask all the questions you have.