Male Infertility

What is Male Infertility?

When a male struggles to impregnate his female partner, he may suffer from infertility. Male infertility is a health issue related to problems with sperm count, the health of the sperm, or if the sperm are being successfully delivered to the egg.

Though not discussed as openly as female infertility, male infertility is just as common. About one-third of all infertility cases can be attributed to male infertility. In another third of all cases, the cause is related to female infertility, and in the remaining third, infertility is caused by a combination of problems in both partners.

Many factors can lead to male fertility, including overall health and lifestyle. In some cases, no cause can be identified. Despite its challenges, male infertility is not necessarily a permanent condition, and many men successfully become fathers with the appropriate diagnosis and treatment.

How Does Male Fertility Normally Work?

Male fertility is a complex process requiring many different areas to function properly. Here is how male fertility normally works:

1. Sperm Production (Spermatogenesis): This process starts in the testicle. The testicles contain coiled masses of tubes called seminiferous tubules. These tubules are responsible for producing immature sperm cells. These cells take about two to three months to develop into mature sperm.
2. Sperm Maturation: Once sperm are produced, they move into the epididymis, a tube at the back of each testicle. Over a period of several weeks, the sperm mature and gain the ability to move on their own, which helps them find an egg to fertilize.
3. Sperm Delivery: Mature sperm are stored in the epididymis until ejaculation. During ejaculation, sperm mixes with fluid from the prostate and seminal vesicles to form semen, which is then expelled from the body through the penis.

For conception to occur, at least one sperm must travel up the female partner’s reproductive tract, from the vagina through the cervix and uterus to the fallopian tube, where it can fertilize an egg if one is present. The whole process requires that every step function correctly: the production of enough healthy, mature sperm and the successful delivery of these sperm to the female partner’s egg.

Causes of Male Infertility

There are several potential causes of male infertility, many of which relate to issues in sperm production or delivery. Here are some common causes of male infertility:

1. Varicocele: A varicocele is an enlargement of the veins within the scrotum that can cause low sperm production, poor sperm quality, or both. This is the most common reversible cause of male infertility.
2. Infection: Certain infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
3. Ejaculation Issues: These include retrograde ejaculation (semen entering the bladder instead of emerging through the penis during orgasm), certain genetic diseases such as cystic fibrosis, and surgical complications or medications.
4. Antibodies Attacking the Sperm: Immune system cells can mistakenly identify sperm as harmful invaders and attempt to eliminate them.
5. Tumors: Cancers and benign tumors can affect the male reproductive organs directly through the glands that release hormones related to reproduction or through unknown causes. Surgery, radiation, or chemotherapy to treat tumors can also affect male fertility.
6. Hormone Imbalances: The hypothalamus, pituitary, and testicles produce hormones necessary for creating sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.
7. Certain Medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer treatments like chemotherapy, certain antifungal and antibiotic medications, and other drugs can impair sperm production and decrease male fertility.
8. Environmental Factors: Overexposure to certain environmental elements such as heat, toxins, and chemicals can reduce sperm production or function. Specific causes include industrial chemicals, heavy metals, radiation or X-rays, and overheating the testicles.
9. Lifestyle Factors: Drug use, alcohol, smoking, prolonged stress, obesity, and inadequate vitamin C and Zinc in the diet can affect fertility.
10. Chromosomal or Genetic Causes: Certain genetic syndromes can cause male infertility, such as Klinefelter’s syndrome, Y chromosome deletion, and others.
11. Problems With Sexual Intercourse: These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, structural issues with the penis, or psychological or relationship problems that interfere with sex.

Diagnosis of Male Infertility

Diagnosing male infertility begins with a comprehensive medical evaluation. The doctor will take a detailed medical history, conduct a physical examination, and order several tests. Here’s what you can expect:

1. Medical History: This involves discussing your overall health, sexual health, past diseases, chronic health issues, and lifestyle factors with your doctor. Your doctor may ask about your sexual habits, libido, whether you’ve fathered a child before, and if you’ve experienced issues with sexual desire or function. They will also ask about any childhood diseases, surgical history, and whether you have a family history of reproductive problems.
2. Physical Examination: A thorough physical examination can detect varicoceles and other issues in the testicles and penis. Your doctor will also check for signs of hormone problems, such as changes in hair growth or breast enlargement.
3. Semen Analysis: This is the most important test for understanding the cause of male infertility. The laboratory will assess your semen volume, sperm count (number of total sperm and the concentration of sperm), sperm movement (motility), and sperm shape (morphology).
4. Specialized Sperm Function Tests: A variety of tests can be performed on a semen sample to evaluate sperm function and help identify potential causes of infertility. These might include testing the sperm’s ability to attach to and penetrate an egg or how well sperm can survive after ejaculation.
5. Blood Tests: Your doctor may order blood tests to examine hormone levels, and in some cases, to check for genetic issues.
6. Imaging Tests: Scrotal ultrasound or other imaging tests can help identify issues such as retrograde ejaculation and ejaculatory duct obstruction. In some cases, a transrectal ultrasound may be used to check the prostate and seminal vesicles.
7. Genetic Testing: If the doctor suspects there may be a genetic cause for your infertility, genetic testing can identify specific obstacles to fertility and problems with sperm.

Diagnosing male infertility is crucial in developing an effective treatment plan. However, even with extensive testing, the underlying cause of male infertility may not be identified.

Treatment of Male Infertility

Treating male infertility involves addressing underlying medical conditions or making lifestyle changes. The type of treatment a man receives depends on the cause of his infertility, if known. Here are three possible treatments for male infertility:

1. Surgery: For some conditions, such as varicoceles or blockages in the sperm transport system, surgery may be recommended.
2. Medications: Doctors might prescribe medication or hormone replacement in cases where infertility is caused by high or low levels of certain hormones or issues with how the body uses hormones.
3. Lifestyle Changes: Lifestyle and habit changes often can improve fertility, especially if you quit smoking, limit your alcohol intake, maintain a healthy weight, and stay physically active.

In some cases, the cause of male infertility can’t be determined. However, even if the exact cause isn’t clear, your doctor may be able to recommend treatments or procedures that will result in conception.

Assisted Reproductive Technology (ART)

Assisted Reproductive Technologies (ART) are advanced procedures that help to increase the chances of conception in individuals and couples struggling with infertility. The utilization of ART in male infertility can be especially useful when natural conception is unlikely due to low sperm count, poor sperm quality, or problems with sperm delivery.

Here are the most common forms of ART used in treating male infertility:

1. Intrauterine Insemination (IUI): In this process, sperm are washed and concentrated, then directly inserted into the woman’s uterus at ovulation. IUI can be timed with a woman’s natural cycle or synchronized with fertility medications. This procedure helps get sperm closer to the fallopian tubes, where egg fertilization occurs.
2. In Vitro Fertilization (IVF): During IVF, the woman’s eggs are collected and then fertilized with the man’s sperm in a laboratory. After a few days, the fertilized egg, now an embryo, is inserted into the woman’s uterus. IVF can be used when the man’s sperm count or sperm motility is low.
3. Intracytoplasmic Sperm Injection (ICSI): ICSI is often used in severe cases of male infertility. It is a form of IVF that involves directly injecting a single sperm into an egg. Once the egg is fertilized, it’s transferred into the woman’s uterus, just like in conventional IVF. ICSI can help couples conceive even when there are very few healthy sperm available.
4. Sperm Retrieval Techniques: For men who have a blockage preventing sperm from being released, or for those who have a very low or non-existent sperm count, sperm can be directly extracted from the testicles or epididymis and can be used in conjunction with IVF or ICSI.
5. Testicular Mapping or Sperm Mapping: For men with non-obstructive azoospermia (no sperm in the semen due to low production), a technique called sperm mapping can help find areas in the testicles where sperm are present. The located sperm can then be extracted and used for IVF or ICSI.
6. Donor Sperm: In some cases, a couple may decide to use donor sperm for IUI or IVF, particularly if the male partner produces no sperm or the sperm is of very poor quality. Sperm donors go through a rigorous screening process to ensure the health and quality of the sperm.

Frequently Asked Questions

How do I know if I am infertile?

A couple is generally considered infertile if they’ve been having regular, unprotected sex for one year without conception. “Regular” is typically two to three times per week. If the female partner is older than 35, the timeframe is often shortened to six months due to the natural decrease in fertility with age. Both the man and woman should be evaluated to learn if one or the other, or both, have fertility issues.

Can lifestyle choices impact male fertility?

Yes, lifestyle factors such as smoking, alcohol consumption, drug use, poor diet, and lack of exercise can negatively impact male fertility. Excessive heat to the testicles, caused by tight clothing or frequent use of hot tubs, can also affect sperm production.

At what age does male fertility decline?

While men can remain fertile into their 60s and beyond, the quality and quantity of sperm can start to decline around age 40.

Does frequent ejaculation affect sperm count?

While frequent ejaculation can affect the volume of semen, it doesn’t necessarily lead to infertility. If you’re trying to conceive, your healthcare provider may recommend abstaining from ejaculation for a certain period before attempting to conceive.

Can male infertility be prevented?

Some causes of male infertility can be prevented by maintaining a healthy lifestyle and avoiding smoking, limiting alcohol, keeping weight in check, avoiding sexually transmitted infections, and managing stress. However, some factors, like genetic conditions, can’t be prevented.

Is male infertility a common problem?

Yes, male infertility is a common problem affecting about one in six couples trying to conceive. In about one-third of cases, male infertility is the sole contributing factor.

Is male infertility permanent?

Not always. Many causes of male infertility are treatable, allowing the man to conceive naturally. In other cases, assisted reproductive technologies can help couples achieve pregnancy.

Can I still have a healthy sex life if I’m dealing with infertility?

Absolutely. While infertility can lead to stress and anxiety, which may impact sexual performance, the physical ability to have sexual intercourse is generally not affected by infertility. Emotional support and stress management strategies can be very helpful in maintaining a healthy sex life during this period.