Male Infertility

What is infertility?

Infertility is the failure of a couple to become pregnant after having regular sexual intercourse without birth control for at least 1 year. Infertility is a problem for 1 of every 6 couples. It can be caused by problems in a man's or woman's reproductive system. Problems in the man's body are responsible for about 20% of the cases of infertility.

How does male infertility occur?

Most often a man is infertile because he produces too few sperm or no sperm at all. Reasons for this may be:

• exposure to toxic chemicals or radiation
• a genetic disorder, such as Klinefelter's syndrome, which can cause a decrease in the male hormone testosterone or problems that affect fertility
• taking frequent, long, hot tub baths
• smoking
• alcohol or drug abuse
• a severe mumps infection as a teen or adult
• hormone disorders
• infections of the genital organs, which can block the passage of sperm
• severe injury to the testicles
• wearing tight underwear, such as jockey shorts, all the time
• having sexual intercourse too often (every day) so there is not enough time to develop mature sperm

Sometimes the sperm are abnormal. That is, they are malformed and cannot swim properly or they have a short lifespan. (A normal sperm has a lifespan of about 3 days.) For example, abnormal sperm can result from:

• testicles that are irritated and swollen (a possible complication of having mumps as an adult)
• a varicocele, which is a swelling of veins in the scrotum (the scrotum is the sac that holds the testicles)
• abnormally developed testicles

Sometimes the problem is getting the sperm into the woman's vagina (ejaculation). Problems with ejaculation may include:

• ejaculation that happens too early during lovemaking
• retrograde ejaculation (semen is forced back into the man's bladder), which may be caused by bladder, prostate, or urethral surgery; diabetes; or some medicines
• inability to keep an erection (possibly due to side effects of some medicines or diseases such as Peyronie's disease)

Other possible causes are:

• severe injury, major surgery, or medical illness, such as diabetes
• abnormalities of the penis
• medicines such as steroids
• using lubricants during sex (they can make it harder for the sperm to reach the egg)
• the natural decline in fertility that comes with aging, especially after age 40

How is it diagnosed?

At first, both partners will probably see a primary healthcare provider. You may then be referred to a specialist. Men usually see a urologist.

You and your partner will have thorough physical exams. You will be asked about:

• your sexual history, including previous pregnancies
• your medical and family history
• medicines that you take
• your use of drugs, alcohol, and tobacco
• exposure to chemicals, for example, at your job
• your sexual intercourse practices, such as how often you have sex, whether you use lubricants, and if you have any problems during sex

Men may have the following tests:

• tests of semen to check the number and quality of sperm in the semen
• blood tests to check for a hormone imbalance, infections, or other illness
• tests of fluid from the penis to check for infections
• ultrasound scans.

How is it treated?

If you have a disorder causing infertility, treatment may include medicine (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments for both partners is necessary.

Possible treatments for a man's infertility are:

• Taking hormones for a hormone imbalance.
• Taking medicines to help you make more sperm.
• Taking an antibiotic to clear up an infection.
• Avoiding long, hot showers and frequent use of hot tubs and saunas. High temperatures can reduce your sperm count. It also may help to wear boxer shorts rather than jockey shorts.
• Stopping use of lubricants during sex.
• Having sex less often.
• Quitting smoking if you are a smoker.
• Quitting use of alcohol or illegal drugs.
• Having therapy to treat ejaculation problems.
• Having surgery to correct a disorder in the testicles or to remove a blockage of the tubes that carry the sperm.

If your sperm count is low, artificial insemination may be an option. Semen is collected at several different times and stored until there are enough sperm. The semen is then placed in your partner's uterus or fallopian tubes during the most fertile time of her menstrual cycle. This procedure has varying success. If your sperm count is still too low or there is something else wrong with your sperm, you may want to consider using sperm donated by another man. If you choose to use sperm donated by another man, only use sperm banks that properly screen for sexually transmitted diseases and other medical illnesses in the donor and his family.

In vitro fertilization is another option: Eggs are removed from the woman and fertilized with sperm in the lab. The fertilized eggs are then put back into the woman's body. This procedure may be done if your sperm count is low or your partner's fallopian tubes are blocked or damaged.

Looking for and treating causes of infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through difficult times.

How can I help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or some illnesses. However, you can do the following to reduce your risk of having problems that might cause infertility:

• Prevent sexually transmitted diseases by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Do not have sexual intercourse every day.
• Do not use lubricants during sexual intercourse.
• Limit the amount of alcohol you drink to no more than 1 to 2 drinks a week.
• Avoid the use of street drugs (such as heroin) and overuse of prescription and nonprescription drugs.
• Do not smoke.
• Avoid exposure to toxic substances such as industrial chemicals, weed killers, and pesticides.
• Avoid exposure to excess radiation.
• Avoid long, hot tub baths and wearing tight underwear.
• Maintain good personal hygiene and health practices.
• Take any hormones, antibiotics, or other medicines as prescribed by your healthcare provider.