Male Infertility 101: Causes, Symptoms and Treatment
When couples face challenges conceiving, it can leave them searching for answers. While many assume infertility is primarily a female issue, male infertility is far more common than people realize.
“Male infertility is estimated to contribute to 50 percent of all infertility cases,” says Dr. James Kashanian, director of Male Sexual Health and assistant professor of Urology and Reproductive Medicine at Weill Cornell Medicine. Additionally, “it’s the sole cause of a couple’s infertility in 20 to 30 percent of cases.”
If infertility is affecting you or a man you love, understanding what to look for and what to do can help you detect and treat this problem.
Common Causes of Infertility in Men
Lifestyle choices, environmental exposure and medical conditions can all impair fertility. You may experience male infertility due to the following:
- Environmental exposure. Excessive alcohol intake or exposure to Agent Orange, cigarettes, fungicides, insecticides or pesticides may result in male infertility. Microplastic particles may affect fertility as well. The effect of microplastics is in early research stages. However, initial findings indicate that plastic material from food wrapping and other sources may affect reproduction.
- Genetic mutations. Mutated genes that cause Klinefelter syndrome, Young syndrome and other conditions may cause fertility issues in men.
- Hormonal issues. “Abnormal hormone levels can lead to poor male fertility,” Dr. Kashanian says. These levels may be due to hyperthyroidism, iron overload syndrome, head trauma and other conditions.
- Infections. You may experience male infertility if you have tuberculosis, frequent urinary tract infections or a sexually transmitted infection.
- Medication. A wide variety of drugs, such as alpha-blockers for an enlarged prostate and opioids, can affect fertility.
- Urogenital abnormalities. Issues affecting the urinary tract and genitals, such as an undescended testicle, can affect sperm production or delivery. These conditions are primarily congenital (you’re born with them).
- Varicoceles. Varicoceles are dilated veins in the scrotum. They are the most common treatable cause of male infertility and the most common cause of secondary infertility.
- Cancer and chronic disease. Tumors in the male reproductive system, including testis cancer, can affect fertility. Certain chronic diseases may also result in infertility. For example, up to 98 percent of men with cystic fibrosis experience infertility, according to the Cystic Fibrosis Foundation.
- Erectile dysfunction. Difficulty achieving and maintaining an erection can be at the root of male infertility. So can premature ejaculation, irregular sexual intercourse and other sexual health issues.
Could It Be Male Infertility?
Men can experience infertility at any age.
“Instead of producing healthy sperm, you may have a low sperm count or poor sperm quality,” Dr. Kashanian says. “Your sperm may have an abnormal shape or move improperly. Any of these make pregnancy unlikely.”
If you engage in regular unprotected sex for at least a year without achieving pregnancy, you may have male infertility. Proper testing can lead to a diagnosis and treatment plan.
First Steps Toward Diagnosis
Diagnosing and treating male infertility starts with understanding the underlying issue. To do this, expect the following:
- Discussion. Your provider will ask about your health history, dating back to childhood. They will also ask if you’ve had or currently have mumps, diabetes or other illnesses. You’ll discuss your use of medication, illicit substances, environmental exposures and other factors that may affect fertility.
- Physical examination. Your health-care provider will examine your genital area for obvious issues with the testicles, penis and vas deferens.
Specific Tests for Male Infertility
Based on the results of your initial examination, your provider may recommend one or more tests. These may include:
- Hormone testing. If your provider suspects you have a hormonal problem, you may undergo blood tests to review your hormone levels. This can detect the root of your problem and rule out several serious health issues.
- Semen analysis. Laboratory technicians evaluate a semen sample to determine the amount and health of your sperm. Your care provider may require multiple tests for a definitive diagnosis.
- Ultrasound. An ultrasound provides a noninvasive way to identify functional problems. Your provider may use this to detect varicoceles, tumors and/or blockages of the ejaculatory ducts or seminal vesicles.
- Testicular biopsy. Although not often necessary as a diagnostic test, a laboratory expert examines a small sample of testicle tissue to determine the source of male infertility. You may receive local or general anesthesia during the tissue removal.
Treating Male Infertility
Male infertility doesn’t always require treatment. Sometimes it resolves on its own. When treatment is appropriate, options include:
- Lifestyle changes. Obtaining and maintaining a healthy weight, getting more exercise and avoiding sperm-reducing drugs and chemicals can improve fertility. Also, while evidence isn’t conclusive, you may benefit from wearing loose-fitting underwear (boxers) and avoiding saunas and hot baths.
- Medication. Antibiotics can help manage infections. For male infertility caused by hormonal problems, hormone replacement therapy may help.
- Microdissection testicular sperm extraction. Unfortunately, some men may have no sperm in their ejaculate. In these cases, surgery is required to try to retrieve sperm directly from the testicle. The sperm retrieved through surgery, in combination with in vitro fertilization, gives couples the chance to have children.
- Assisted reproductive technology (ART). When infertility persists after other treatments, you may benefit from intrauterine insemination or in vitro fertilization (IVF). With IVF, your sperm is combined with your partner’s egg in a laboratory setting. Your care provider may suggest injecting a single sperm into the egg, a procedure known as intracytoplasmic sperm injection (ICSI). A few days after fertilization, a health-care provider places the embryo into your partner’s uterus. If successful, the embryo grows into a fully developed child.
At Weill Cornell Medicine, providers offer these and other advanced approaches to male infertility. Through the Center for Male Reproductive Medicine & Microsurgery, we also perform groundbreaking research to improve infertility knowledge and treatment options.
“Happily, many couples treated for infertility are able to have babies,” Dr. Kashanian says. “It’s a privilege to play a role in helping good people grow their families.”
Could you be living with male infertility? Find a doctor at Weill Cornell Medicine to determine what’s causing your fertility issue.