Infertility In Men
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 due 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
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:
- Genetics diseases, such as Klinefelter syndrome and Sertoli-Leydig cell syndrome
- Exposure to workplace chemicals or heavy metals, such as primarily lead and cadmium
- Tobacco use and marijuana use
- Varicocele —enlarged veins within the scrotum
- Abnormal hormone levels
- Physical abnormalities
- Chronic diseases, such as sickle cell anemia
- Excessive physical activity
- Anti-sperm antibodies
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, opiate use, and certain prescription drug use
- Exposure to diethylstilbestrol (DES) in the womb
- Overheating of the testicles
- Cystic fibrosis
- Klinefelter syndrome
- Kartagener syndrome
- 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
Inability to have a child after one year of trying to conceive.
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
Images may be taken of your bodily structures. This can be done with:
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
Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.
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
Ask you doctor if a daily antioxidant supplement may help.
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 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.
Infertility cannot always be prevented; however, the following steps may help:
- 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.
American Society for Reproductive Medicine
RESOLVE: The National Infertility Association
Men's Health Centre
I'm a guy; isn't this a woman's issue? Protect Your Fertility website. Available at: http://www.protectyourfertility.org/malerisks.html. Accessed October 27, 2014.
Infertility in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2014. Accessed October 27, 2014.
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;17:2199.
Reproductive health and the workplace. The National Institute for Occupational Safety and Health website. Available at: http://www.cdc.gov/niosh/topics/repro. Updated June 10, 2014. Accessed October 27, 2014.
Swan SH, Brazil C, Drobnis EZ, et al. Geographic differences in semen quality of fertile US males. Environ Health Perspect. 2003;111:414.
9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Ghanem H, Shaeer O, El-Segini A. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Fertil Steril. 2009 Mar 5. [Epub ahead of print]
2/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Showell M, Brown J, Yazdani A, Stankiewicz M, Hart R. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2011;(1):CD007411.
Last reviewed December 2014 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.