If you and your partner have been trying for a year or more to have a child, you might be experiencing male infertility. Doctors define male infertility as the inability to conceive a child after one year of unprotected sex, or six months if you and your partner are over 35.
Studies have shown that in this one-year window, about 12% to 15% of couples under age 35 are unsuccessful in conceiving a child. Another 10% will remain unsuccessful after two years of unprotected sex.
Male infertility can often be treated with medication or surgery.
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What is Male Infertility?
Male infertility is a condition of the male reproductive system that prevents a couple from having children. If a couple has been trying to conceive a child for more than a year without success, they are given a diagnosis of infertility. For couples over the age of 35, this conception window is six months.
How common is male infertility?
Infertility in men is not uncommon. According to the American Pregnancy Association, infertility affects one in every six couples. Male infertility makes up about 30% of all infertility cases.
What causes male infertility?
Many things can interfere with the process of conceiving a child. Sperm must be healthy, functional, and transferred into the semen. There must also be enough sperm in the semen. If any of these conditions are not met, the result is male infertility.
Male infertility can be caused by health complications or situations such as:
A high level of anti-sperm antibodies in the bloodstream.
- Cancer treatments.
- Certain medications
- Chronic health conditions.
- Ejaculation issues.
- Genetic disorders or variations.
- Genital infections.
- Hormone imbalances.
- Infection in the prostate or testicles.
- Low sperm count.
- Poor-quality sperm cells.
- Prostatitis.
- Varicoceles — A collection of varicose veins in the scrotum.
Other potentially linked lifestyle causes include:
- Environmental factors, such as exposure to certain chemicals.
- Heavy alcohol consumption.
- Sexually transmitted infections (STIs).
- Smoking cigarettes or marijuana, or being exposed to their secondhand smoke.
- Spending long periods in hot tubs.
The risk of male infertility increases with:
- Alcohol use.
- Depression.
- Drug use.
- Stress.
- Testosterone replacement therapy.
- Tobacco use.
Male infertility risk factors
The most common risk factors for male infertility include:
- Age — Couples having difficulty conceiving often include a male partner over age 40.
- Genetics — Family history, inherited factors, and genetic conditions can cause male infertility.
- Lifestyle risks — Such as not exercising, poor nutrition, smoking, heavy drinking, and drug use.
How can I reduce my risks of male infertility?
While there isn’t one fix-all trick to cure male infertility, there are certain lifestyle choices that you can make now to help lower your chances of struggling to conceive in the future, such as:
- Don’t get a vasectomy.
- Drink less alcohol.
- Limit activities that bring heat to the groin area (hot tubs, saunas, etc.).
- Limit drug use.
- Limit stress.
- Smoke tobacco and marijuana less.
- Maintain a healthy weight with diet and exercise.
Complications of male infertility
Male infertility can lead to emotional and psychological issues, which can also affect sperm quality. These issues may also impact relationships and daily life. Behavioral health therapy is recommended to help cope with the emotions that infertility can bring up.
Men who cannot find success with treatment options will be unable to conceive a child using their own sperm.
What Are the Signs and Symptoms of Male Infertility?
Infertility is based on couples making consistent efforts to conceive over time.
In general:
- For couples under age 35, one year or longer of trying unsuccessfully to conceive may be a sign of infertility.
- For couples over 35, a six-month period of unprotected sex without conception may be a sign of infertility.
Physical symptoms of male infertility beyond the inability to conceive are uncommon. However, someone may show symptoms related to another condition that can cause infertility.
For example, if a man has a hormone imbalance, he may experience changes in hair growth.
Some symptoms that have been associated with male infertility include:
- Difficulty with sexual function.
- Low sperm count, which a doctor can determine with a lab test.
- Pain in the testicles.
- Swelling in or directly above the testicles.
- Unusual breast growth.
When should I see a doctor about my male infertility symptoms?
Since infertility in men can have several causes, you should speak to your doctor if you are trying to conceive and you've experienced:
- An injury to the testicles.
- Exposure to toxins like cadmium, lead, or mercury.
- Heavy alcohol drinking.
- Heavy substance use, including marijuana, heroin, or cocaine.
- High blood pressure.
- Mumps as a child.
- Radiation or chemotherapy.
- Use of anabolic steroids or overuse of testosterone.
- Weight issues or, if you're currently overweight.
In addition, if you are over 35 and have been trying to conceive for six months, or under 35 and have been trying for more than a year, it may be time to talk with your doctor about infertility.
How Do You Diagnose Male Infertility?
To diagnose male infertility, a doctor will often start by reviewing your medical history, including asking questions about your current lifestyle habits. They may also suggest a physical analysis, request a blood test to review your hormone levels, and perform a semen analysis to learn more about your sperm count.
Male infertility can be diagnosed by your primary care provider at a routine check-up. But if infertility has been an ongoing issue, you might want to see a urologist.
Your doctor might ask you if you’ve had a high fever recently or about your family and medical history, as well as about your sex drive.
They may also do a physical exam to look at your:
- Body hair — A lack of hair might signal a hormone imbalance.
- Penis — For any discharge or swelling that might be signs of an infection or sexually transmitted infection (STI).
- Testicles — For signs of a hernia, malformation, damage, or a mass (tumor).
- Scrotum — For abnormal veins (varicocele) that can affect sperm quality.
Any of these conditions may affect your body’s testicular or ejaculatory functions.
If your doctor can't diagnose your infertility through a physical exam, they might ask for a sperm sample for semen analysis.
Tests to diagnose male infertility
Semen analysis
Semen analysis is one of the most important tools in determining male infertility and sperm abnormalities.
Once sperm enters the vagina, it must travel through cervical mucus and the cervix to reach the uterus to fertilize an egg. Conditions that impede this process may be attributed to male infertility.
A trained urologist will perform the analysis and look for these factors:
- Concentration — Measures how close the sperm are together in the sample. Low concentration may be a sign of a problem.
- Count — The number of sperm in the entire sample. A low count may make conception difficult.
- Morphology — The number of normally shaped sperm. Abnormally shaped sperm may not be able to fertilize an egg.
- Motility — The percentage of sperm moving forward. Sperm must be able to move forward to fertilize an egg.
- pH — The acidity of your semen. High acidity can kill sperm or affect their motility.
- Volume — The amount of semen in the sample. Low volume may cause infertility.
- White blood cells (leukocytes) — May be a sign that an infection is affecting your fertility.
A unique aspect of sperm production is that ejaculated sperm is developed in the testicles three months before they're released. So, the determining factors may or may not still be present in the sperm sample you provide.
Genetic testing
Male infertility is sometimes caused by a genetic disorder, such as Klinefelter’s syndrome. In these cases, doctors must do genetic testing to determine the cause.
How Do You Treat Male Infertility?
Doctors have several options for treating male infertility, depending on the cause of your infertility.
Lifestyle changes
In certain cases, your doctor may simply recommend some habit changes, such as:
- Abstaining from alcohol, drugs, marijuana, and tobacco.
- Avoiding hot showers, hot tubs, and saunas.
- Maintaining a healthy weight.
- Taking supplements.
- Wearing looser clothing.
Medicines to treat male infertility
If your doctor determines that an infection is at the root of your infertility, they will likely prescribe an antibiotic. For a hormone imbalance, you may be given oral hormones or hormone injections to correct it.
Medication to treat erectile dysfunction may help if needed, as well.
Your doctor may also refer you to an endocrinologist, who may recommend drug therapies that affect the hypothalamus or thyroid.
Surgery for male infertility
If you have abnormally formed tubes in the testicles that are blocking the transport of sperm from the testicles to the penis, you may need surgery to repair them. Likewise, if you have a varicocele, or varicose veins in the scrotum, surgery may help reverse infertility.
Testicular surgery can be done as an outpatient surgery, and recovery takes about one to two weeks. These surgeries are typically performed by a urologist.
Many men see an improvement following surgery, but the procedure may not be as effective if there are multiple causes of infertility.
Assisted reproductive technology (ART) for male infertility
Couples who need assistance to get pregnant can find assisted reproductive technology (ART) to be very effective in producing a fertilized egg.
These therapies include:
- Intracytoplasmic sperm injection (ICSI) — One single sperm is injected into a mature egg before being placed in the uterus.
- Intrauterine insemination (IUI) — Sperm is injected directly into the uterus.
- In vitro fertilization (IVF) — Sperm is introduced to an egg in a laboratory to create an embryo. The embryo is then placed into the uterus after a few days or frozen for future transplant to the uterus.
ART procedures may require the use of donor eggs or sperm for couples who can't produce their own healthy sperm or eggs, or for same-sex couples. Donor eggs or sperm may also be used as a preventive measure should the mother or father carry a genetic disorder that's likely to be passed down to the baby.
There are very few risks that go along with infertility treatments for men. While any surgery has the chance for error or injury, there is a low risk of bleeding and infection for men who undergo sperm extraction during ART treatment.
If you or someone you know is experiencing male infertility, here is a list of resources with more information about the condition. For any questions or concerns, make an appointment to speak with one of our specialists today.
