Male Infertility

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Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Male infertility means the male is unable to impregnate the female because of male factors. Learn what the causes of male infertility are and discover if you can resolve your male infertility issues with your doctor.

What is going on in the body?

The inability to get pregnant may be caused by conditions in either partner. It is estimated that 30% of infertility is caused by male factors. An additional 30% is caused by female factors. The remaining 40% is caused by a combination of female and male factors. Male infertility may be caused by many diseases, conditions, and other factors. Situations that raise the temperature in the testicles can interfere with normal sperm production.

What are the signs and symptoms of the condition?

Male infertility occurs when the man's partner does not conceive after one year of attempting to become pregnant. Other signs and symptoms depend on the underlying cause of the man's infertility.

What are the causes and risks of the condition?

There are many male factors that can make a couple unable to become pregnant. These may include conditions such as the following:

• diabetic neuropathy, in which nerve damage causes problems with erection or ejaculation
• extreme obesity hormone imbalances, such as hypothyroidism
• hypogonadism, a condition in which the testes fail to develop normally
• inherited conditions that impair the ability to produce sperm, such as Down syndrome
• testicular torsion, a condition in which the blood supply to the testicle is cut off
• undescended testicles, a condition in which the testes fail to drop into the scrotum
• varicocele, a group of enlarged veins inside the scrotum

Diseases also can be a factor in infertility, for example:

• autoimmune disorders, which can cause the body to produce antibodies that attack sperm
• liver disease
• sickle cell anemia
• kidney disease
• genital infections such as gonorrhea and genital herpes
• infections of the reproductive organs, such as prostatitis and epididymitis
• infectious diseases, including mumps

Additional factors in infertility include the following:

• certain medications, such as cimetidine and phenytoin
• certain supplements, such as anabolic steroids
• chemotherapy used for cancer
• diet low in folic acid or low in lycopene, which is found in plants such as tomatoes
• excessive exercise, which lowers testosterone levels and decreases sperm production
• exposure to diethylstilbestrol, also known as DES, as an infant in utero
• exposure to toxins such as lead, mercury, or pesticides
• frequent hot baths or use of hot tubs
• injury to the testicles
• low sperm count, poor sperm quality, and poor movement of sperm
• radiation therapy
• recreational drugs, such as alcohol, methadone, and marijuana
• sexual problems, such as erectile dysfunction and premature ejaculation
• side effects of treatments for testicular cancer or prostate cancer
• surgery of the reproductive system, such as transurethral resection of the prostate
• vasectomy, a surgical procedure to tie off the sperm-carrying tubes
• wearing tight-fitting pants and underwear
• work that requires prolonged sitting, which increases the temperature in the scrotum

A recent study has found that baby boys who wear diapers lined with plastic have significantly higher temperatures inside the testicles. The researchers suggest that disposable diapers may have contributed to the increase in male infertility over the past 25 years.

What can be done to prevent the condition?

Some cases of male infertility may be avoided by doing the following:

• Avoid drugs and medications known to cause fertility problems.
• Avoid excessive exercise.
• Avoid exposure to environmental hazards such as pesticides.
• Avoid frequent hot baths or use of hot tubs.
• Avoid tight underwear or pants.
• Eat a diet with adequate folic acid.
• Get early treatment for sexually transmitted diseases.
• Have regular physical examinations to detect early signs of infections or abnormalities.
• Keep diseases, such as diabetes and hypothyroidism, under control.
• Practice safer sex to avoid sexually transmitted diseases.
• Take a lycopene supplement.
• Wear protection over the scrotum during athletic activities.

Although more research needs to be done, parents may want to consider alternatives to disposable diapers for male infants.

How is the condition diagnosed?

The diagnosis of infertility begins with a medical history and physical exam. The provider may order blood tests to look for hormone imbalances or disease. A semen sample may be needed. The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed.

What are the long-term effects of the condition?

Male infertility can create tension in a couple's relationship. Sexual relations may become less pleasurable. Fertility evaluations can be expensive. Eventually, 85% of couples find a cause for their inability to conceive. However, some couples never become pregnant, even with the newest treatments. Adoption may be the best choice in some cases.

What are the risks to others?

Male infertility is not contagious. However, male infertility can be caused by a sexually-transmitted disease, which may be transmitted to sexual partners.

What are the treatments for the condition?

Treatment of male infertility focuses on the underlying cause. Without treatment, 15% to 20% of infertile couples will eventually get pregnant. Treatment for a male with infertility may include:

• avoiding extended periods of time in hot baths and hot tubs
• eating a healthy diet and exercising in moderation
• having a varicocele surgically repaired
• having vasectomy reversal surgery, which reconnects the tubes carrying sperm from the testes
• learning about the best times to conceive
• making lifestyle changes, such as smoking cessation and limiting intake of alcohol
• taking antibiotics for any diagnosed infection
• taking hormone therapy
• treating erectile dysfunction with counseling, medication, or surgery
• wearing loose-fitting underwear, such as boxer shorts

If these treatments don't work, other means of fertilization may be considered, such as:

• artificial insemination. This involves placing sperm directly in the cervix or uterus.
• intracytoplasmic sperm injection. This involves placing individual sperm cells directly inside the woman's eggs.
• in vitro fertilization. This involves fertilizing the egg outside the womb and then returning it to the uterus.

What are the side effects of the treatments?

Surgery can cause bleeding, infection, and allergic reactions to anesthesia. In vitro fertilization increases the chance of having a multiple pregnancy, such as twins. Antibiotics and other medications may cause stomach upset, diarrhea, or an allergic reaction.

What happens after treatment for the condition?

Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

How is the condition monitored?

The man can monitor his own ability to impregnate a woman. Any new or worsening symptoms should be reported to the healthcare provider.