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.

Symptoms

The main sign of male infertility is not being able to start a pregnancy. There may be no other symptoms.

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.

Causes

There are many causes of male infertility. Sometimes there's more than one cause.

The causes of infertility may involve any of the following. To get your partner pregnant, you need to:

• Make healthy sperm. This starts with the growth of the male reproductive organs during puberty. At least one of your testicles must work. And your body must make testosterone and other hormones to be able to make sperm.
• Have sperm that gets into the semen. Once the testicles make sperm, tubes carry them until they mix with semen. Ejaculation takes them out of the penis.
• Have enough sperm in the semen. If the number of sperm in your semen, called the sperm count, is low, it lowers the odds of one of your sperm fertilizing your partner's egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
• Have sperm that works and moves. If your sperm doesn't move or work as it should, the sperm may not be able to reach your partner's egg or get inside it.

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.

Causes in the environment

Being around certain elements such as heat, toxins and chemicals can cause you to make less sperm or keep the sperm from working well. Causes include:

• Industrial chemicals. Being around certain chemicals, pesticides, herbicides, organic solvents and painting products for a time may be part of low sperm counts.
• Heavy metal. Being around lead or other heavy metals also may cause infertility.
• Radiation or X-rays. Being around radiation can lessen sperm making, though it often returns to the usual amount in time. High doses of radiation can lessen sperm making long term.

• Heat on the testicles. High temperatures may harm sperm making and affect how sperm works. Some studies suggest that using saunas or hot tubs may lower sperm count for a time.

  Sitting or working on a laptop computer for long periods and wearing tight clothing also may raise the temperature in the scrotum. This may cut sperm making a bit. More research is needed.

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.

Risk factors

Risk factors linked to male infertility include:

• Lifestyle choices that aren't healthy. This includes smoking and using alcohol and certain illicit drugs.
• Issues with the testicles, such as injury, having had a vasectomy or major belly or pelvic surgery, keeping the testicles too warm or having testicles that didn't come down from the belly into the scrotum.
• Having certain past or present infections.
• Being around toxins.
• Being born with a fertility condition or having a blood relative with a fertility condition.
• Having certain medical conditions, including obesity, tumors and long-term illnesses, such as sickle cell disease and celiac disease. Having sleep apnea or otherwise sleeping poorly also can affect sperm.
• Taking certain medicines or having medical treatments, such as surgery or radiation for treating cancer.

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.

Prevention

Male infertility isn't always preventable. But you can try to stay away from some known causes of male infertility. For instance:

• Don't smoke.
• Limit or don't drink alcohol.
• Don't use illicit drugs.
• Stay at a healthy weight.
• Don't do things that heat the testicles.
• Lower stress.
• Stay away from pesticides, heavy metals and other toxins.