Male Infertility Explained: Causes, Symptoms, Testing, & More

The concept of getting pregnant appears to be a simple task, though there are many phenomena that often go unnoticed internally within both male and female bodies during this process. When there are complications in conceiving, these factors often end up under the microscope. For men, it can be a difficult topic to breach at times, though rest assured, male factor infertility is common and makes up 50% of infertility diagnoses. This article will review what constitutes male factor infertility, its causes, and some possible options to navigate the diagnosis.

What is Male Infertility?

According to the World Health Organization (WHO), failure to get pregnant is defined as clinical infertility if pregnancy is not established after 12 months or more of regular unprotected sexual intercourse. Male infertility is used to classify infertility when the female partner is known to be fertile. Male infertility is a clinical diagnosis that can only be determined after formal assessment and testing. Infertility is a common issue; Infertility affects an estimated one in every seven couples who are trying to conceive. In at least half of all cases of infertility, a male factor is a major or contributing cause.

What Can Cause Male Infertility?

The most common causes of male infertility are problems related to the ejection of semen, motility of the sperm, morphology, and low level or absence of sperm. Many biological and environmental factors can also impact fertility.

Possible causes of male infertility include:

• Genetic Diseases: Examples include Klinefelter syndrome, myotonic dystrophy, and microdeletion.
• Varicocele: A varicocele occurs when the veins in the scrotum that drain blood from the testis become abnormally dilated and large. This causes them to overheat, which can affect the shape or number of sperm.
• Testicular inflammation or injury.
• Oligospermia: The production of low- or poor-quality sperm.
• Malformed sperm: Sperm that cannot live long enough to fertilize the egg.
• Undescended testes: Cryptorchidism means ‘hidden testis’ and is a condition where one or both testes are not in their normal position in the lower part of the scrotum. It is commonly called “undescended testes”.
• Hormonal disorders: Disorders that affect the hypothalamus or pituitary glands can affect fertility.
• Severe illness and cancer treatments: Chemotherapy, radiation, or surgery that removes the testis.
• Unhealthy habits: Heavy alcohol use, smoking, illegal drug use, and anabolic steroids.

What Are the Symptoms of Male Infertility?

While there may be no obvious signs of male infertility, there are a few warning flags to look out for, such as:

• Trouble ejaculating - either no ejaculation or very low volume of semen.
• Problems with sexual function - difficulty obtaining and maintaining an erection.
• Reduced sexual desire or loss of libido.
• Pain, swelling, or a lump in the testicle area.
• Signs of hormonal imbalance, such as decreased facial or body hair, abnormal breast growth (gynecomastia) etc.
• Unusual loss of or reduction in the sense of smell.
• 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) – can be determined by an extensive semen analysis.

When to See a Doctor to Get Male Infertility Evaluated and Diagnosed?

Men should be evaluated for infertility if they have not participated in a successful pregnancy after 12 months of timed intercourse. They should be evaluated sooner if there are infertility risks below:

• Erection or ejaculation problems, low sexual 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.

What Tests Are Done to Determine Male Factor Infertility?

Diagnosis begins with a complete physical examination to determine the general state of health and identify any physical problems that may impact fertility.

A comprehensive semen analysis is usually ordered by a physician, which includes:

•       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 the whole ejaculate.
•       Velocity: How fast the sperm travels.
•       Motility: The movement of sperm.
•       Morphology: Size and shape of sperm.
•       Viscosity: How fast semen liquefies.

What Are the Treatment Options?

Not all male infertility is permanent or untreatable. With advanced modern technology and methods, the number of treatment options for male infertility has expanded.

Medications:

Hormone therapy can help to increase the number of sperm. Some may be required to self-administer hormone injections such as Pergonal or Humegon. A doctor can also refer a patient to a urologist who prescribes them with antibiotics to correct a transient sperm abnormality if diagnosed with an infection.

Surgeries:

• Vasectomy: This surgery is performed on men to remove the swollen testicular veins. This method is successful if you have a significantly enlarged varicocele. A surgeon will fix the problem by bypassing the blockage in the epididymis.
• Intracytoplasmic sperm injection (ICSI): This method is to inject a single sperm into an egg. This procedure has significantly changed the treatment available for even the most severe male factor infertility. Because of this technique, most of all infertile males have the potential to conceive their own genetic child. This technique is now commonly used for men with vasectomies and has made it possible to avoid painful and often unsuccessful reversal surgeries.
• Testicular biopsy (TESE): In some severe cases, a biopsy of the testicle is required to find sperm. This technique utilizes a procedure called testicular extraction of sperm (TESE), which involves inserting a thin biopsy needle inside the testicles (under local anesthesia). A small amount of testicular tissue is then aspirated, which separates the sperm present in the sample. This sperm is then used to inject into an available egg to assure fertilization.

Lifestyle Change:

Avoid damaging environmental factors, such as smoking, heat exposure, heavy exercise, toxicants, certain drugs, or excessive alcohol. Reduce stress levels, and maintain healthy body weight by exercising and eating a healthy diet.

How Can You Prevent Male Factor Infertility?

Male infertility isn't always preventable. However, here are some known practices that can support male fertility:

• Refrain from smoking.
• Limit or abstain from alcohol.
• Avoid illicit drugs.
• Maintain a healthy BMI.
• Avoid vasectomy.
• Avoid things that lead to prolonged heat for the testicles.
• Reduce stress levels.
• Avoid exposure to pesticides, heavy metals, and other toxins.

For additional information on male factor infertility, please reach out to us or your primary care physician.