Infertility in Men

Overview

Definition

Infertility is not being able to conceive after a year of regular, unprotected sex. About one-third of infertility is caused by male factors and one-third are caused by female factors. In the remaining cases, the cause is unknown or is related to problems with both partners.

Men are considered infertile if they:

  • Produce too few sperm cells
  • Produce sperm cells of poor quality
  • Have chronic problems with ejaculation
The Male Reproductive System
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Causes

Portions of the brain called the pituitary gland and hypothalamus, as well as male reproductive organs such as the testes affect fertility in men. Problems in any of these areas may decrease fertility.

In about half of the cases, a cause cannot be found. Some factors that can contribute to infertility include:

  • Genetic diseases such as Klinefelter syndrome and Sertoli-Leydig cell syndrome
  • Exposure to workplace chemicals or heavy metals, such as primarily lead and cadmium
  • Tobacco and marijuana use
  • Enlarged veins within the scrotum—varicocele
  • Abnormal hormone levels
  • Infections
  • Physical abnormalities
  • Cancer
  • Medications
  • Obesity
  • Chronic diseases such as sickle cell anemia
  • Excessive physical activity
  • Anti-sperm antibodies

Risk Factors

Factors that may increase your chance of developing infertility include:

  • Exposure to toxic chemicals or heavy metals, such as lead
  • Liver disease
  • Nicotine use, long-term marijuana or cocaine use , steroid use, opioid use , and certain prescription drug use
  • Exposure to diethylstilbestrol (DES) in the during fetal development
  • Chemotherapy
  • Malnutrition
  • Overheating of the testicles
  • Cystic fibrosis
  • Klinefelter syndrome
  • Kartagener syndrome
  • Diabetes
  • Spinal cord injuries
  • Multiple sclerosis
  • Brain tumors , pituitary tumors
  • Radiation treatment
  • Past infections, including sexually transmitted diseases (STDs), mumps , and prostatitis
  • Birth defects of the male reproductive system, including history of undescended testicles
  • Obesity, high body mass index

SymptomsandDiagnosis

Symptoms

Inability to have a child after one year of trying to conceive.

Diagnosis

During the first visit, you and your partner will both be evaluated. You will be asked about your symptoms, medical history, and work history. Your doctor will look for potential exposure to certain chemicals. Your doctor will also look for physical problems that might cause infertility.

Your bodily fluids and tissues may be tested. This can be done with:

  • Blood tests
  • Semen analysis
  • Biopsy

Images may be taken of your bodily structures. This can be done with:

  • Ultrasound
  • X-rays

Other tests may include:

  • Fertilization tests—to determine how well the sperm can penetrate an egg
  • Post-coital test—to check if your sperm is compatible with the mucus in your partner's cervix

Treatments

Treatment

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Lifestyle Changes

Lifestyle changes may include:

  • Changing the timing of sexual activity
  • Avoiding excessive heat, such as steam rooms and saunas
  • Avoiding tobacco , marijuana, and excessive alcohol use
  • Wearing looser fitting shorts and pants
  • Maintaining a healthy weight
  • Decreasing stress

Medication

If you have a hormonal imbalance, your doctor may prescribe medication. Clomiphene citrate, for example, is an anti-estrogen drug. In combination with vitamin E, it may help increase sperm count and improve sperm movement.

Surgery

Surgery is done for conditions like varicocele that can affect fertility. Treatment of a varicocele does not always restore fertility.

Surgery may also be done to reverse a vasectomy . This reversal is not always successful.

Assisted Reproductive Technologies (ART)

ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from you and your partner or donated. ART methods include:

  • Artificial insemination—Semen is collected and processed in a lab. It is then inserted directly into the woman's cervix or uterus.
  • In vitro fertilization (IVF)—An egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
  • Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—An egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.
  • Blastocyst intrafallopian transfer—An egg is removed from the woman's body. The egg is injected with sperm and allowed to develop. It is later implanted into the uterus.
  • Intracytoplasmic sperm injection—A single sperm is injected into the egg. The resulting embryo can be implanted into the uterus or frozen for later use.

Prevention

To help reduce your chances of infertility:

  • Avoid:
    • Use of tobacco, marijuana, opiates, and anabolic steroids
    • Exposure to harmful chemicals and heavy metals
    • Excessive use of alcohol
  • Protect yourself from STDs by using condoms . Minimize the number of sexual partners you have.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Male Infertility)

RESOURCES

Reproductive Facts—American Society for Reproductive Medicine http://www.reproductivefacts.org 

Resolve—The National Infertility Association https://resolve.org 

CANADIAN RESOURCES

Men's Health Centre http://www.menshealthcentre.net 

Sex & U—the Society of Obstetricians and Gynaecologists of Canada https://www.sexandu.ca 

References

Infertility. Protect Your Fertility website. Available at: http://www.protectyourfertility.org/malerisks.html. Accessed December 18, 2017.

Infertility in men. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T902812/Infertility-in-men . Updated December 4, 2017. Accessed December 18, 2017.

Jorgensen N, Carlsen E, Nermoen I, et al. East-West gradient in semen quality in the Nordic-Baltic area: a study of men from the general population in Denmark, Norway, Estonia and Finland. Hum Reprod. 2002;17(8):2199-2208.

Reproductive health and the workplace. National Institute for Occupational Safety and Health (NIOSH) website. Available at: https://www.cdc.gov/niosh/topics/repro. Updated April 20, 2017. Accessed December 18, 2017.

9/2/2010 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T902812/Infertility-in-men : Ghanem H, Shaeer O, El-Segini A. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Fertil Steril. 2010;93(7):2232-2235.

2/14/2011 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T902812/Infertility-in-men : Showell M, Brown J, Yazdani A, Stankiewicz M, Hart R. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2011;(1):CD007411.