What is Male Infertility?

When a couple has been trying to conceive without success for one year (six months if both are over 35), it is an indication that there are potential fertility issues that need to be explored with a fertility specialist.

One of the common misconceptions about couples who are having difficulty conceiving is that the infertility problem usually lies with the female. The reality is that in half of these situations, the issue lies with the male’s reproductive system.

Natural male reproduction depends on the creation of healthy sperm that can fertilize an egg. It also depends on a male having an erection and ejaculation so that the sperm can reach an egg.

A problem with either of these male conditions can result in male infertility. As with female infertility, male infertility can have many symptoms, causes, and solutions.

While the inability to conceive a child when having regular intercourse in a 6 month to 1 year time frame can be stressful and frustrating for couples, there are a number of treatments available to help natural conception be more possible. Furthermore, if natural conception proves elusive, there are many other options for achieving conception with one’s partner.

Male Infertility Causes

Problems with making healthy sperm are the most common of male infertility issues. Sperm disorders include low sperm count, the inability of sperm to swim, abnormally shaped sperm, and poor-quality sperm DNA. In some cases, a male may not be producing any sperm, or there may be disorders of sperm delivery such as obstruction.

These sperm disorders may be the result of:

  • Anatomical abnormalities such as varicocele (varicose veins of the testicle) or history of undescended testicle
  • Environmental and lifestyle factors such as heavy use of tobacco, alcohol, steroids, marijuana, or the exposure to toxins
  • Hormone or pituitary gland problems
  • Use of testosterone or workout supplements
  • Genetic disorders such as being a carrier for cystic fibrosis or having an extra or misplaced portion of a chromosome
  • Medical problems like history of cancer or uncontrolled diabetes
  • Childhood surgeries, including hernia repair, or prior testicular injuries
  • Infections or inflammatory conditions, for example, the effect of covid-19 infection
  • Vasectomy

There are also structural problems that can cause male infertility. Anything that blocks a male’s genital tract can stop the flow of semen. This might be the result of a genetic or birth defect; an infection or inflammation from a sexually transmitted disease, scar tissue from surgery; or dilated veins in the scrotum called varicocele.

Men with a history of childhood surgeries or serious illnesses are, unfortunately, at higher risk for infertility. If this is the case, it may be beneficial to undergo a semen analysis before attempting to conceive.

The Most Common and Most Severe Causes of Male Infertility

One of the most common causes of male infertility is varicocele, a dilation of the veins that stem from the testicle. This is readily diagnosable by a physical exam with a reproductive urologist. Fortunately, varicocele surgery is one of the most cost-effective treatments of male factor infertility.

One of the most severe forms of male infertility is azoospermia. This is the complete absence of sperm in the ejaculate. Azoospermia can be obstructive or non-obstructive. Obstructions may be treatable with reconstructive surgery or sperm retrieval and IVF, while non-obstructive azoospermia usually requires sperm retrieval and IVF.  Non-obstructive azoospermia is treatable with a procedure called micro-TESE that allows a reproductive urologist to find and retrieve sperm using an operating microscope.

With severe male infertility, a backup or alternative to biological sperm is the use of donor sperm.  Anonymous donor sperm can be purchased from an online sperm bank and shipped to the fertility clinic for intrauterine insemination (IUI), in vitro fertilization (IVF), or as a backup for treatments such as sperm retrieval for azoospermia.

Still other factors contributing to infertility may include erectile dysfunction or premature ejaculation. Kidney or liver disease, or treatments for seizure disorders, are also examples of problems that can cause infertility.

Male Infertility Symptoms

An obvious sign of potential male infertility is the inability of a couple to conceive. In some cases, however, there are infertility symptoms that may also be signs, including:

  • Pain, swelling, or a lump in the testicle or groin areas
  • Problems with sexual function such as difficulty with ejaculation, small volumes of fluid ejaculated, difficulty maintaining an erection (erectile dysfunction), or lack of interest in sex
  • Urinary, bladder, or prostate symptoms such as urinary frequency, burning, incontinence, or difficulty voiding.
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair
  • Difficulty sleeping
  • Depression or significant stress
  • Being older than 45 years of age

How is Male Infertility Diagnosed?

The diagnosis of male infertility often begins with a health history and physical exam. Diagnostic tests may include:

  • Sperm count (semen analysis). Typically 2 semen samples are taken on separate days. The semen will be checked for semen volume, sperm concentration, and sperm motility.
  • Advanced semen tests. Some patients may be recommended to undergo additional semen testing to evaluate the DNA quality of the sperm called DNA fragmentation testing.
  • Blood tests are used to check hormone levels and to rule out genetic problems.
  • Imaging tests like ultrasound may be used to look at your testicles, blood vessels, and structures inside the scrotum.
  • Testicular biopsy. If the semen analysis shows that you have few sperm or no sperm, a testicular biopsy (the removal of a small amount of tissue) may be done so the tissue can be examined under a microscope and sperm can be frozen for later use with IVF.

Male Infertility Treatment Options

Treatment of male infertility depends on what is causing your infertility and what can help your partner get pregnant with your sperm. It might include:

  • Lifestyle improvements. A patient’s risk factors will be assessed and recommendations for healthier life choices will be made, including tobacco cessation, decreased alcohol consumption, avoidance of testosterone and workout supplements, improved sleep, weight loss, and improved diet.
  • Hormone treatment: Hormonal disorders may be caused by a problem in how your pituitary gland and testes interact which affect how sperm develop. Treatments may include hormone modulators such as clomiphene citrate or gonadotropin therapy.
  • Surgery: Surgery can repair dilated, varicose veins in the scrotum (varicocele repair) which can often improve the quality of sperm. Additionally, sperm retrieval procedures can help men with severely abnormal semen quality, those who are azoospermic (no sperm in the ejaculate), and those with disorders of erection or ejaculation. In men with a history of vasectomy, a vasectomy reversal or a sperm retrieval can be considered.
  • Artificial insemination. This treatment, also known as intrauterine insemination (IUI) inserts a well-timed, highly concentrated sample of healthy sperm into your partner’s uterus with the hope that the sperm will make their way to the fallopian tubes.
  • IVF and ICSI. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICS) is assisted reproduction where fertilization and embryo development occurs in the embryology laboratory. The sperm is collected, and a high-quality sperm is selected and then injected into your partner’s egg to create an embryo which can then be transferred back to your partner’s uterus.

When to Contact a Male Infertility Doctor

You should see an infertility specialist if you and your partner have been unable to conceive a child after a year of regular, unprotected sex or if you have any of the following issues:

  • Erection or ejaculation problems, other problems with sexual function, or a low sex drive
  • Pain, discomfort, or a lump or swelling in the testicle area
  • A groin, testicle, penis, or scrotum surgery in your medical history
  • A history of testicle, prostate, or sexual problems
  • The male partner is over 45 years of age
  • The female partner is over 35 years of age

Fertility Clinics Handle Each Unique Situation

Every couple’s situation is unique. If you have questions about infertility or need help identifying if you need fertility assistance, a fertility clinic can help. The mission of Atlantic Reproductive Medicine in Raleigh, NC, is to provide the highest possible level of personalized fertility care. If you have questions, contact us or schedule a preconception counseling appointment on our website with our experts.

Key points about Male Infertility

  • 50% of couple infertility is caused by male reproduction issues.
  • Male infertility may be due to a wide range of problems including environmental or occupational exposures, lifestyle factors, varicose veins in the scrotum (varicocele), sperm production problems, blockages in the genital tract, or genetic problems.
  • Most types of male factor infertility can be identified and successfully treated to improve natural fertility or optimize assisted reproductive technology (ART) outcomes.
  • Male factor infertility treatment may include lifestyle modifications, medicines, and surgery, often in conjunction with assisted reproductive technology (ART) like intrauterine insemination (IUI) and in vitro fertilization (IVF).