Male Infertility

What is male infertility?

Infertility is a problem with your reproductive system that stops you from impregnating a female. If a male and a female have repeated unprotected sex for over a year and the female doesn’t get pregnant then you, she, or both of you may have infertility issues.

How common is male infertility?

Infertility is a common issue, with more than five million couples in the United States dealing with this problem. Infertility affects one in every six couples who are trying to conceive. In at least half of all cases of infertility, a male factor is a major or contributing cause. This means that about 10% of all males in the United States who are attempting to conceive suffer from infertility.

Is it easy to conceive?

No. Conception is a complicated process that depends on many factors:

• The production of healthy sperm by the male and healthy eggs by the female.
• Unblocked fallopian tubes that allow the sperm to reach the egg.
• The sperm's ability to fertilize the egg when they meet.
• The ability of the fertilized egg (embryo) to become implanted in the female’s uterus.
• Good embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the female’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can happen.

Which males are more likely to have infertility?

Some males are more likely than others to experience infertility. You might be more likely if:

• You have overweight or obesity.
• You’re age 40 or older.
• You’ve been exposed to radiation.
• You’ve been exposed to environmental toxins including lead, calcium, pesticides or mercury.
• You use tobacco, marijuana or alcohol.
• You’re taking some medications including cyproterone, flutamide, spironolactone, bicalutamide, cimetidine or ketoconazole.
• You’re around heat that raises the temperature of your testes. Those who frequently use a sauna, hot tub or wheelchair might experience this.
• You have a history of undescended testicle(s).
• You have a history of varicoceles, which are widened veins in your scrotum.
• You’ve been exposed to testosterone. Some males need injections, implants or topical gel for low testosterone.

What causes male infertility?

Many biological and environmental factors can impact your fertility. Possibilities include:

• Azoospermia: Your infertility can be related to your inability to produce sperm cells.
• Oligospermia: The production of low or poor quality sperm.
• Genetic diseases: Examples include Klinefeflter’s syndrome, myotonic dystrophy, microdeletion and more.
• Malformed sperm: Sperm that cannot live long enough to fertilize the egg.
• Some medical conditions: Examples include diabetes, some autoimmune disorders, cystic fibrosis and some infections.
• Some medications and supplements.
• Variococles: This is a condition where the veins on your testicles are larger than normal, causing them to overheat, which can affect the shape or number of your sperm.
• Cancer treatments: Chemotherapy, radiation or a surgery that removes the testicles (one or both).
• Unhealthy habits: Substance use, including alcohol, smoking and drugs.
• Trauma to your testes.
• Hormonal disorders: Disorders that affect your hypothalamus or pituitary glands can affect your infertility.

What are the symptoms of male infertility?

The infertility itself is the symptom. However, it’s much more difficult to describe the negative psychological and emotional symptoms infertility has on a couple who wants to have children. Many times, conceiving a child becomes the total focus of their lives. Feelings of depression, loss, grief, inadequacy and failure are common in males as well as females seeking pregnancy.

Individuals or couples experiencing any of these feelings may want to seek professional help from healthcare providers like a therapist or psychiatrist experienced in dealing with infertility issues. Such providers can help you deal realistically with the situation and provide support even while you are going through treatment.

How is male infertility evaluated and diagnosed?

Diagnosis begins with a complete physical examination to determine your general state of health and identify any physical problems that may impact your fertility. Your healthcare provider may also interview both you and your partner about your sexual habits. If the physical examination and history don’t indicate any reason for your inability to conceive, the next step may be to conduct testing to identify the cause of infertility.

What tests are done?

First, your healthcare provider may do a semen analysis. It determines the following:

• Sperm volume: Amount of sperm per ejaculate.
• pH: A measurement of acidity or basicity.
• Sperm concentration: Number of sperm per millimeter of semen.
• Total sperm count: Number of sperm in your whole ejaculate.
• Velocity: How fast your sperm travels.
• Linearity: How straight your sperm moves.
• Morphology: Size and shape of your sperm.
• Color.
• Viscosity: How fast your semen liquefies.

Next, your healthcare provider may do a detailed sperm analysis, which examines your sperms’:

• Viability, or ability to survive.
• Morphology, or quality and shape.
• Motility, your sperm’s ability to move to the egg and fertilize it.

Other possible tests include:

• Leukocytospermia quantitation/Endtz test.
• Kruger's strict morphology classification.
• W.H.O. morphology for sperm assessment.
• Special staining for azoospermic specimen.
• Semen biochemistry fructose test.
• Sperm antibody tests (direct and indirect immunobead).
• Reactive oxygen species.
• Sperm DNA assessment.

Which healthcare providers diagnose male infertility?

Ask your primary healthcare provider to refer you to an urologist who specializes in male infertility. You may also work with a reproductive endocrinologist.

What questions might a healthcare provider ask to diagnose male infertility?

• How long have you been trying to get your partner pregnant?
• Have you gotten a partner pregnant in the past?
• Do you smoke? Drink alcohol? Use recreational drugs?
• What medications are you on?
• Do you work in an environment where you’re exposed to chemicals?
• Have you ever experienced trauma in your groin area, such as from a car crash?
• Are you experiencing any mental health issues such as clinical depression?
• What medical conditions do you have? Diabetes? An autoimmune disorder?
• Have you ever been exposed to radiation?

How is male infertility treated?

With modern technology and methods, the number of treatment options for male infertility has expanded. Depending on the cause of infertility, treatments may include:

Medications:

• Hormone therapy to increase the number of sperm.

Lifestyle changes:

• Maintain a body weight that's healthy for you.
• Stop smoking.
• Stop drinking.
• Stop using marijuana.
• Stop any recreational drug use.

Surgeries:

• Vasectomy reversal: This common procedure is an outpatient surgery. The surgeon reconnects your vas deferens which is the tube in the scrotum through which your sperm passes. Viewing the vas deferens through a high-power surgical microscope, the surgeon carefully sews the ends back together.
• Vasoepididymostomy: Blockages in your vas deferens are repaired with a similar technique. Your vas deferens is surgically split, the blockage is removed and the ends of the tube are reconnected. When the original vasectomy was performed many years previously, an additional blockage may have formed in the epididymis, the coiled tube that lies against your testicle where sperm cells mature. Blockage at the epididymis also can occur due to infection or injury. Whatever the cause, your surgeon will fix the problem by bypassing the blockage in the epididymis.
• Sperm Retrieval: In some severe cases, a biopsy of the testicle is required to find sperm.

Other:

• Intracytoplasmic sperm injection: Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection (ICSI) has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile males have the potential to conceive their own genetic child.
• In vitro fertilization: For some couples dealing with male infertility, in vitro fertilization (IVF) is the treatment of choice. During the IVF process, the ovaries are stimulated with injectable fertility medications to cause multiple eggs to mature. When the eggs are ready, they are collected in a minor procedure. Fertilization is accomplished by exposing the eggs to sperm in a culture dish, or by directly injecting a single sperm into each mature egg, a process called intracytoplasmic sperm injection (see above). After fertilization, embryo development is monitored over the next three to five days, and two to three embryos are then placed into the uterus by way of a small catheter inserted through the cervix

In intracytoplasmic sperm injection (ICSI), a single sperm is injected into an egg in a special culture medium. This illustration shows the development of an embryo following fertilization of the egg using ICSI.

Can male infertility be prevented? How can I reduce my risk of infertility?

If your infertility is affected by lifestyle choices such as smoking and working around certain chemicals, you might be able to reduce your risk. Talk to your healthcare provider about other risk factors and what you can do about them.

If you’re going to go through cancer treatment, talk to your healthcare provider about sperm banking.

What’s the outlook for males with infertility?

Just because you have issues with infertility, that doesn’t mean you’ll never be able to have your own child. There are treatment options. If you work together with your partner and an urologist, you can increase your chances of conception.

Can male infertility go away on its own?

Male infertility requires treatment in most cases.

When should I see my healthcare provider?

If you and your partner have been unable to get pregnant after a year of trying, see your healthcare provider. See a therapist or psychiatrist if you’re struggling with mental health problems.

What questions should I ask my healthcare provider about male infertility?

Don’t hesitate to ask your healthcare provider questions about infertility. Some to consider include:

• What’s the cause of my infertility?
• Should my partner get tested?
• What’s the best treatment for me?

A note from Cleveland Clinic

Remember that about 10% of all males in the United States who are attempting to conceive suffer from infertility. You are not alone in your struggle. Because of modern technology, 90% of all infertile males have the potential to conceive their own genetic child. There are treatments for the causes of infertility, lifestyle changes you can make to prevent infertility and there are surgeries and procedures to try. Remember to speak to a healthcare provider if you and your partner haven’t been able to conceive after a year of unprotected sex.