Infertility in Men
Male infertility means a male is not able to get his fertile female partner pregnant. Pregnancy does not happen after a year of regular, unprotected sex.
Males are considered infertile if they:
- Produce too few sperm cells
- Make poor quality sperm cells
- Have long term problems with releasing sperm
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Male infertility may be caused by problems that:
- Affect sperm numbers and health, such as:
- Certain infections or inflammatory conditions
- Hormone or pituitary gland problems
- Exposure to certain toxins, drugs, or radiation
- Certain genetic diseases
- Block the flow of semen, such as:
- Genetic or birth defects
- Certain sexually transmitted infections (STIs)
- Scarring from surgery or swollen veins in the scrotum
- Other health conditions such as:
- The body attacks its own sperm
- Certain long-term diseases
Many times a cause cannot be found.
Lower fertility is more common in males over 35 years old. Many things can raise the risk, such as:
- Working with toxic chemicals or heavy metals, such as lead
- Tobacco or excess alcohol use
- Using drugs or medicine, such as:
- Overheating of the testicles
- Genetic problems such as:
- Spinal cord injuries
- Other health problems, such as:
- Radiation treatment
- Past infections, including:
The symptom is not being able to cause pregnancy after one year of trying to with:
- Regular, unprotected sexual intercourse
- A fertile female partner
The doctor will evaluate the person and his partner. They will be asked about sex, symptoms, past health, and work history. The doctor will look for exposure to certain chemicals. The doctor will also look for physical problems that might cause infertility.
Body fluids and tissues may be tested with:
- Blood tests—to check hormone levels and rule out other problems
- Semen analysis—to check sperm count
- Biopsy—to test a small tissue sample from the testes
Images may be taken to look for problems in the male organs. This can be done with:
Other tests may check:
- How well the sperm penetrate an egg
- If the person's sperm survive in their partner's cervical mucus
Treatment depends on what is causing the problem.
The doctor may advise making changes, such as:
- Changing the timing of sexual activity
- Avoiding excessive heat, such as steam rooms and saunas
- Avoiding tobacco , marijuana, and excess alcohol use
- Wearing looser fitting shorts and pants
- Maintaining a healthy weight
- Decreasing stress
Male hormone imbalances can affect how sperm grow. An imbalance may be treated with certain medicines.
Surgery may be used to fix problems that:
- Prevent sperm from being made
- Keep sperm from growing
- Stop sperm from being ejaculated
Surgery is done for conditions like varicocele that can affect fertility. This does not always restore fertility.
Surgery may also be done to reverse a vasectomy. This reversal is not always successful.
To help reduce the risk of infertility:
- Use of tobacco, marijuana, opiates, and anabolic steroids
- Exposure to harmful chemicals and heavy metals
- Excessive use of alcohol
- Protect yourself from STIs by using condoms. Limit your number of sexual partners.
Help with Making a Pregnancy
Other treatments may help the male's partner get pregnant. Options may include:
- Artificial insemination—Healthy sperm are collected and put in the uterus.
- In vitro fertilization (IVF)—An egg is removed from the female's body. It is then mixed with sperm in a lab. The egg and sperm mixture is then put in the uterus.
- Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—The egg and sperm mixture is put in the fallopian tube.
- Blastocyst intrafallopian transfer—An egg is removed from the female's body. The egg is injected with sperm and allowed to develop. It is later implanted into the uterus.
- Intracytoplasmic sperm injection—A single sperm is injected into the egg. The fertilized egg is put into the uterus or frozen for later use.
- Agarwal A, Baskaran S, et al. Male infertility. Lancet. 2021;397(10271):319-333.
- Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res. 2019;8:F1000 Faculty Rev-670.
- Infertility: an overview. American Society for Reproductive Medicine website. Available at: https://www.reproductivefacts.org/globalassets/_rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/infertility-an_overview_booklet2.pdf.
- Male infertility. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/male-infertility.
- Reproductive health and the workplace. National Institute for Occupational Safety and Health (NIOSH) website. Available at: https://www.cdc.gov/niosh/topics/repro.
- Mark Arredondo, MD
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