Infertility is a challenging issue that affects many couples worldwide. It can affect all genders. Often, it’s treatable. That’s why correct diagnosis is important in order to help those who are affected. Male infertility is less thoroughly investigated than female infertility, even though it accounts for about half of infertility problems faced by couples globally (1, 2). For more information about female infertility, click here.
This article is pending medical review.
Contributors
Written by Carolin Becker
Reviewed by Lea Dörner, Alessandra Papitto and Sophie Oppelt
Edited by Juliëtte Gossens
Male infertility refers to the inability of a person with male reproductive organs (a penis and testicles) to cause a pregnancy after 12 months of unprotected sex.
Worldwide, at least 30 million men are affected by infertility. The number might be much higher, because in many countries, mainly the female partner is blamed for infertility due to cultural and social reasons. Therefore, reports and infertility evaluations are often inaccurate.
As we explain here, infertility doesn’t mean that you’ll never be able to cause a pregnancy. That’s very unlikely. By infertility, we mean that your chances of causing a pregnancy are reduced, so that it might take longer before it happens. How small your chances are depends on the cause of the infertility and the severity of the issue.
Infertility can be a temporary or permanent condition. How likely you are to cause a pregnancy varies, depending on the underlying cause and the treatment you’re getting (3). There are various reasons for why one may experience infertility. In the male reproductive system, infertility is most commonly caused by genetic mutations, lifestyle factors or medications (1). We address these causes further in this article.
It is important to note that infertility can be caused by male or female factors, or a combination of both. Therefore, both partners should ideally be evaluated and treated for infertility if necessary. Infertility can have a negative social impact on the lives of affected people. Male fertility research and education are particularly important in reducing gender inequity and making starting a family realistic for more people (2). Furthermore, an increasing number of male infertility cases have been observed in developing countries, making it even more important to address this topic. The reasons for this are not quite clear yet. It’s possible that increasing rates of obesity and an increasing age of first-time fathers contribute to the problem (3).
In this article, we will discuss some of the common causes of male infertility, how it is diagnosed and available treatment options.
What we're covering
Causes of Male Infertility
In 30% of cases, no cause for male infertility can be found. But there are several factors that can contribute.
Semen parameters: Male infertility is mostly caused by alterations in the so-called semen parameters. These include sperm count, sperm shape and sperm motility (movement) (1).
Low sperm count: A low sperm count (<20 million/milliliter) is the most common cause of male infertility. This can be attributed to hormonal imbalances, infections, genetic disorders, and health factors such as obesity, smoking or alcohol use (1).
Abnormal sperm shape: Abnormal sperm shape, also known as teratozoospermia, can contribute to male infertility. This condition makes it difficult for the sperm to penetrate and fertilize the egg (1).
Sperm motility: Sperm has to travel through the cervical mucus in order to fertilize an egg. Poor sperm motility refers to sperm that moves inefficiently. It might not be able to reach the egg in order to fertilize it (1).
Blockages in the reproductive tract: Blockages in the reproductive tract, for example in the deferens duct, can prevent the sperm from reaching the egg. This can be caused by a variety of factors, including infection, injury, or surgery (3).
Erectile dysfunction: Erectile dysfunction, also known as impotence, can also contribute to male infertility. This condition makes it difficult for a person to get or keep an erection during sex (3).
Medical conditions: Several medical conditions such as cystic fibrosis or multiple sclerosis might contribute to infertility. They do so by affecting for example the semen parameters (1, 3).
Health factors: As mentioned above, health factors such as stress or obesity can lead to changes in the semen parameters and therefore to infertility.
Another underestimated risk factor is age: with increasing age, semen parameters seem to worsen and make pregnancy less likely. In the media, we often see (very) old men who become fathers, so it's definitely possible - it just doesn't happen as easily as with young men. That’s important to note, because male infertility still is a highly stigmatized (taboo) topic and women are often blamed for being infertile when a couple is unable to get pregnant (3). Besides the fact that nobody should be “blamed” for infertility, it’s just as likely that a man’s lifestyle, semen or age is making becoming pregnant difficult.
Diagnosis of Male Infertility
A correct diagnosis of infertility often requires different steps and tests. Below are a couple of regularly used examinations that your doctor might want to do.
Physical examination: The first step in diagnosing male infertility is usually an evaluation of your sexual and medical history. This covers illnesses you’ve had in the past and illnesses you’re still dealing with, including sexually transmitted infections (STDs) such as chlamydia or syphilis.
Some doctors will also want to do a physical examination. They might examine your genitals and testicles for any abnormalities or signs of infection. One of the most common treatable causes of male infertility, the varicocele, can be identified through physical examination. A varicocele is an enlargement of the veins in the scrotum, which can sometimes lead to infertility. It is visible as a painless swelling in the scrotum and can be confirmed using ultrasound. It’s more common as you get older, and it can be removed surgically (1).
Semen analysis: Semen analysis is a laboratory test that examines the quantity, quality, and movement of sperm in the semen (see semen parameters above). This should be done under supervision of a healthcare professional. At-home kits are available but often not as accurate. A semen sample should be collected at least twice, on different dates. That’s because some semen parameters can vary a lot within a few days (1).
Hormone testing: Hormone testing can help identify any hormonal imbalances that may contribute to male infertility. Your doctor might test for levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (1).
Genetic testing: Your doctor might recommend genetic testing if they suspect a genetic cause of your infertility. This may involve analyzing your chromosomes for any abnormalities, or screening for genetic disorders that can affect fertility (4).
Ultrasound: An ultrasound examination can be used to examine the testicles and other parts of the reproductive system for any abnormalities or blockages, such as varicocele (1).
Treatment Options for Male Infertility
Treatment and management of infertility mainly depend on the underlying cause of the condition. You should discuss your particular case with your doctor.
Lifestyle changes: Lifestyle changes such as quitting smoking, reducing alcohol consumption, and maintaining a healthy weight can help improve semen quality and therefore improve fertility. While it sounds easy, changing these things about your lifestyle can be very challenging. Ask your doctor if there is any help available for you. For example, in many places, there are coaches that can help you quit smoking or drinking. Losing weight should ideally also be done under supervision of a trained professional who knows how. Don’t feel ashamed to ask for help – it’s very difficult to do those things on your own!
Medications: There are medications that can be used to treat hormonal imbalances, infections, or other problems that may contribute to infertility (1). But there’s little evidence that vitamins and supplements, that you can get in a drug store or online, improve your fertility. There are studies going on to see if different supplements actually work. Talk to your doctor to see if they can recommend you any.
Surgery: Surgery may be necessary to remove blockages in the reproductive tract or to repair damage caused by injury or infection. One of the most common procedures is the varicocelectomy. That’s a surgical procedure used to treat varicoceles. It has been shown to improve semen quality and increase the chance that you’ll cause a pregnancy (3).
Assisted reproductive technology (ART): In cases where other treatment options are not successful or possible, assisted reproductive technology (ART) might be an option to be considered. Here, the egg and sperm cell are combined in a laboratory to create an embryo. Different procedures can be used to accomplish a pregnancy, with the most common ones being in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) (1, 3). Sperm donation might also be a possibility if you’re open to the idea.
In conclusion, male infertility is a complex issue that can significantly impact a couple's ability to become pregnant. It’s important for people and couples experiencing difficulties in conceiving to seek medical advice and undergo proper diagnostic testing. By identifying the underlying causes of infertility, your doctor can recommend appropriate treatment options to improve the chances of becoming pregnant.
It's essential that you feel free to communicate openly, seek emotional support, and work closely with healthcare professionals throughout your fertility journey. Understanding and addressing male infertility not only offers hope for pregnancy, but also promotes overall reproductive health and well-being.
The diagnosis of male infertility is not the end of the road. With advancements in medical knowledge and technology, many couples can overcome this issue and realize their dreams of starting a family.
References
Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000 Research. 2019;8:670. DOI: 10.12688/f1000research.17076.1.
Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reproductive Biology and Endocrinology. 2015;13:37. DOI: 10.1186/s12958-015-0032-1
Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. In: StatPearls. Treasure Island (USA): StatPearls Publishing; 2023. .
Pelzman DL, Hwang K. Genetic testing for men with infertility: techniques and indications. Translational Andrology and Urology. 2021;10(3):1354-1364. DOI: 10.21037/tau-19-725
Please note: the information we provide to you here is for educational purposes only. If you’re experiencing any discomfort or have any complaints or questions about your health, please contact your doctor or other relevant health professional. We don’t provide medical advice.
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