Nearly 1 in 7
couples is infertile, which means they haven't been able to conceive a child
even though they've had frequent, unprotected sexual intercourse for a year or
longer. In up to half of these couples, male infertility plays at least a
partial role.
Male infertility
can be caused by low sperm production, abnormal sperm function or blockages
that prevent the delivery of sperm. Illnesses, injuries, chronic health
problems, lifestyle choices and other factors may contribute to male
infertility.
The inability to
conceive a child can be stressful and frustrating, but a number of treatments
are available for male infertility.
Symptoms
The main sign of
male infertility is the inability to conceive a child.
In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm causes signs and symptoms.
Problems with sexual function for
example, difficulty with ejaculation or small volumes of fluid ejaculated,
reduced sexual desire, or difficulty maintaining an erection (erectile
dysfunction)
Pain, swelling or a lump in the testicle area.
Recurrent respiratory infections
Inability to smell
Abnormal breast growth (gynecomastia)
Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality.
A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
See a doctor if you
have been unable to conceive a child after a year of regular, unprotected
intercourse or sooner if you have any of the following:
Erection or ejaculation problems, low sex drive, or
other problems with sexual function
Pain, discomfort, a lump or swelling in the
testicle area
A history of testicle, prostate or sexual problems
A groin, testicle, penis or scrotum surgery
A partner over age 35
Causes
You must produce healthy sperm. Initially,
this involves the growth and formation of the male reproductive organs during
puberty. At least one of your testicles must be functioning correctly, and your
body must produce testosterone and other hormones to trigger and maintain sperm
production.
Sperm have to be carried into the
semen. Once sperm are produced in the testicles, delicate tubes transport
them until they mix with semen and are ejaculated out of the penis.
There needs to be enough sperm in the
semen. If the number of sperm in your semen (sperm count) is low, it
decreases the odds that one of your sperm will fertilize 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.
Sperm must be functional and able to
move. If the movement (motility) or function of your sperm is abnormal,
the sperm may not be able to reach or penetrate your partner's egg.
MEDICAL CAUSES
Varicocele. A varicocele
is a swelling of the veins that drain the testicle. It's the most common
reversible cause of male infertility. Although the exact reason that
varicoceles cause infertility is unknown, it may be related to abnormal blood
flow. Varicoceles lead to reduced sperm quantity and quality.
Infection. Some
infections can interfere with sperm production or 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. Although some infections can result in
permanent testicular damage, most often sperm can still be retrieved.
Ejaculation issues. Retrograde
ejaculation occurs when semen enters the bladder during orgasm instead of
emerging out the tip of the penis. Various health conditions can cause
retrograde ejaculation, including diabetes, spinal injuries, medications, and
surgery of the bladder, prostate or urethra.
Antibodies that attack sperm. Anti-sperm
antibodies are immune system cells that mistakenly identify sperm as harmful
invaders and attempt to eliminate them.
Tumors. Cancers and
nonmalignant tumors can affect the male reproductive organs directly, through
the glands that release hormones related to reproduction, such as the pituitary
gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy
to treat tumors can affect male fertility.
Undescended testicles. In some
males, during fetal development one or both testicles fail to descend from the
abdomen into the sac that normally contains the testicles (scrotum). Decreased
fertility is more likely in men who have had this condition.
Hormone imbalances. Infertility
can result from disorders of the testicles themselves or an abnormality
affecting other hormonal systems including the hypothalamus, pituitary, thyroid
and adrenal glands. Low testosterone (male hypogonadism) and other hormonal
problems have a number of possible underlying causes.
Defects of tubules that transport sperm. Many
different tubes carry sperm. They can be blocked due to various causes,
including inadvertent injury from surgery, prior infections, trauma or abnormal
development, such as with cystic fibrosis or similar inherited conditions.
Blockage can occur
at any level, including within the testicle, in the tubes that drain the
testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or
in the urethra.
Chromosome defects. Inherited
disorders such as Klinefelter's syndrome , in which a male is born with two X
chromosomes and one Y chromosome (instead of one X and one Y) cause abnormal development of the male
reproductive organs. Other genetic syndromes associated with infertility
include cystic fibrosis and Kallmann's syndrome.
Problems with sexual intercourse. These can
include trouble keeping or maintaining an erection sufficient for sex (erectile
dysfunction), premature ejaculation, painful intercourse, anatomical
abnormalities such as having a urethral opening beneath the penis
(hypospadias), or psychological or relationship problems that interfere with
sex.
Celiac disease. Celiac
disease is a digestive disorder caused by sensitivity to a protein found in
wheat called gluten. The condition may contribute to male infertility.
Fertility may improve after adopting a gluten-free diet.
Certain medications. Testosterone
replacement therapy, long-term anabolic steroid use, cancer medications
(chemotherapy), some ulcer drugs, some arthritis drugs and certain other
medications can impair sperm production and decrease male fertility.
Prior surgeries. Certain
surgeries may prevent you from having sperm in your ejaculate, including
vasectomy, scrotal or testicular surgeries, prostate surgeries, and large
abdominal surgeries performed for testicular and rectal cancers, among others.
Environmental causes
Industrial chemicals. Extended
exposure to certain chemicals, pesticides, herbicides, organic solvents and
painting materials may contribute to low sperm counts.
Heavy metal exposure. Exposure to
lead or other heavy metals also may cause infertility.
Radiation or X-rays. Exposure to
radiation can reduce sperm production, though it will often eventually return
to normal. With high doses of radiation, sperm production can be permanently
reduced.
Overheating the testicles. Elevated temperatures may
impair sperm production and function.
Health, lifestyle and other causes
Drug use. Anabolic steroids taken to stimulate muscle strength and growth
can cause the testicles to shrink and sperm production to decrease. Use of
cocaine or marijuana may temporarily reduce the number and quality of your
sperm as well.
Alcohol use. Drinking
alcohol can lower testosterone levels, cause erectile dysfunction and decrease
sperm production. Liver disease caused by excessive drinking also may lead to
fertility problems.
Tobacco smoking. Men who smoke
may have a lower sperm count than do those who don't smoke. Secondhand smoke
also may affect male fertility.
Weight. Obesity can
impair fertility in several ways, including directly impacting sperm themselves
as well as by causing hormone changes that reduce male fertility.
Risk factors
Smoking tobacco
Using alcohol
Using certain illicit drugs
Being overweight
Having certain past or present
infections
Being exposed to toxins
Overheating the testicles
Having experienced trauma to the
testicles
Having a prior vasectomy or major
abdominal or pelvic surgery
Having a history of undescended
testicles
Being born with a fertility disorder
or having a blood relative with a fertility disorder
Having certain medical conditions,
including tumors and chronic illnesses, such as sickle cell disease
Taking certain medications or
undergoing medical treatments, such as surgery or radiation used for treating
cancer
Complications
Stress and relationship difficulties
related to the inability to have a child
Expensive and involved reproductive techniques
Increased risk of testicular cancer, melanoma, colon cancer and prostate cancer
Prevention
Don't smoke.
Limit or abstain from alcohol.
Steer clear of illicit drugs.
Maintain a healthy weight.
Don't get a vasectomy.
Avoid things that lead to prolonged
heat for the testicles.
Reduce stress.
Avoid exposure to pesticides, heavy
metals and other toXINS
Diagnosis
General physical examination and
medical history. This includes examining your genitals and asking questions about
any inherited conditions, chronic health problems, illnesses, injuries or
surgeries that could affect fertility. Your doctor might also ask about your
sexual habits and about your sexual development during puberty.
Semen analysis. Semen samples
can be obtained in a couple of different ways. You can provide a sample by
masturbating and ejaculating into a special container at the doctor's office.
Because of religious or cultural beliefs, some men prefer an alternative method
of semen collection. In such cases, semen can be collected by using a special
condom during intercourse.
Ultrasound:This test uses high-frequency sound waves to produce images inside your
body. A scrotal ultrasound can help your doctor see if there is a varicocele or
other problems in the testicles and supporting structures.
Transrectal ultrasound. A small,
lubricated wand is inserted into your rectum. It allows your doctor to check
your prostate and look for blockages of the tubes that carry semen.
Hormone testing. Hormones
produced by the pituitary gland, hypothalamus and testicles play a key role in
sexual development and sperm production. Abnormalities in other hormonal or
organ systems might also contribute to infertility. A blood test measures the
level of testosterone and other hormones.
Post-ejaculation urinalysis. Sperm in your
urine can indicate your sperm are traveling backward into the bladder instead
of out your penis during ejaculation (retrograde ejaculation).
Genetic tests. When sperm
concentration is extremely low, there could be a genetic cause. A blood test
can reveal whether there are subtle changes in the Y chromosome — signs of a
genetic abnormality. Genetic testing might be ordered to diagnose various
congenital or inherited syndromes.
Testicular biopsy. This test
involves removing samples from the testicle with a needle. If the results of
the testicular biopsy show that sperm production is normal your problem is
likely caused by a blockage or another problem with sperm transport.
Specialized sperm function tests. A number of
tests can be used to check how well your sperm survive after ejaculation, how
well they can penetrate an egg, and whether there's any problem attaching to
the egg. These tests aren't often used and usually don't significantly change
recommendations for treatment
Treatment
Surgery. For example,
a varicocele can often be surgically corrected or an obstructed vas deferens
repaired. Prior vasectomies can be reversed. In cases where no sperm are
present in the ejaculate, sperm can often be retrieved directly from the
testicles or epididymis using sperm retrieval techniques.
Treating infections. Antibiotic
treatment might cure an infection of the reproductive tract, but doesn't always
restore fertility.
Treatments for sexual intercourse
problems. Medication or counseling can help improve fertility in conditions
such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications. Your doctor
might recommend hormone replacement or medications in cases where infertility
is caused by high or low levels of certain hormones or problems with the way
the body uses hormones.
Assisted reproductive technology
(ART). ART treatments involve obtaining sperm through normal
ejaculation, surgical extraction or from donor individuals, depending on your
specific case and wishes. The sperm are then inserted into the female genital
tract, or used to perform in vitro fertilization or intracytoplasmic sperm
injection.
LIFESTYLE AND HOME REMEDIES
Increase frequency
of sex. Having sexual intercourse every day or every other day beginning
at least five days before ovulation increases your chances of getting your
partner pregnant.
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