Causes of male infertility

The male is responsible for up to 50% of infertility cases, so initial screenings for male infertility should be performed early in the infertility workup. Let’s start by understanding common causes of male infertility. 

Sperm factor infertility

A semen analysis is commonly used to evaluate male infertility symptoms and treatment options. This analysis evaluates: 

• The volume of the sample produced
• The number of sperm present
• The percentage of motile sperm
• The percentage of normally shaped sperm 

The presence of normal sperm is essential in achieving fertilization and subsequent pregnancy. Male patients can have low sperm counts, a low percentage of sperm swimming, and/or a low percentage of normally shaped sperm. 

Causes of male infertility

Causes of male infertility can be divided into four main categories: 

Disorders affecting the brain 

The hypothalamus and pituitary are essential in producing a normal amount of sperm. For men with irregular hormone releases, sperm will be negatively impacted and infertility can occur. 

Disease in the testicle 

If there are any abnormalities in the testes, this can lead to an abnormality with the sperm that makes it more difficult to successfully fertilize an egg. 

Obstruction in the transport of the sperm

Once sperm are produced in the testicles, they travel through delicate tubes until they mix with semen and eventually ejaculate out of the penis. This is not possible for individuals with blockages in tubes (including the vas deferens) and may be due to vasectomy or injury. 

Unexplained infertility 

Unexplained male infertility is reserved for infertile men with normal semen in which female infertility factors have been ruled out.  

More often than not, however, it is very difficult to explain the cause of low sperm count or motility. Let’s explore some real-life considerations that may contribute to male infertility. 

• Timing of puberty: delayed puberty can be associated with certain diseases such as Klinefelter’s syndrome.
• Childhood illnesses, such as undescended testicles or mumps.
• History of trauma: testicular trauma can lead to vascular injuries that will permanently damage the testicles.
• History of torsion: testicular torsion) occurs when the testicle twists on its pedicle, causing a hindrance to blood flow.
• Previous surgical procedures, such as bladder operations or surgery for testicular cancer.
• History of heat exposure: a generalized febrile illness can interfere with sperm production because of the elevated temperature. One episode of such high fevers can affect the sperm for 3 months until a new batch is formed. Certain activities associated with increased testicular heat can affect sperm count and function, such as frequent use of jacuzzies, saunas, or even hot tub usage. The elevated temperature from these activities might impair sperm production.
• History of exposure to toxins: these toxins, whether occupational, environmental, can affect fertility. Radiation, agricultural chemicals, lead, cancer chemotherapy medications are only a few of these detrimental agents.
• History of smoking: both cigarette smoking and marijuana have been associated with infertility.
• History of venereal diseases, such as Gonorrhea or Chlamydia.
• History of alcohol use.
• Sexual habits including use of lubricants: many such lubricants (K-Y Jelly, Keri lotion) and even saliva have been shown to affect sperm motility.
• Timing of intercourse.
• History of medication intake: a variety of medications can affect reproductive function. Some of these medications include Sulfasalazine (used for colitis treatment), spironolactone (diuretic), Cimetidine (for ulcers), erythromycin, Gentamicin (antibiotics).

Diagnosing male infertility

To determine the cause of male infertility, your fertility clinic or doctor can perform a semen analysis to check the count, motility, and shape of sperm. The diagnosis of male infertility might fall in the following categories:

• Unexplained: One of the most common diagnoses, usually due to a genetic factor.
• Varicocele: Swelling of the veins present around the testicular ducts (epididymis) can cause a slow blood flow with a resultant increase in temperature and therefore interfere with sperm count and function. This is one of the most common male infertility diagnoses.
• Obstructive: This could be due to an inborn genetic abnormality, such as the absence of the vas deferens, or it could be acquired from surgery or infection.
• Immunologic: This could be due to the presence of sperm antibodies that attach to the sperm head and interfere with fertilization of eggs. 
• Environmental: These include medications, radiation or chemical exposure.
• Hormonal: Abnormalities in the secretion of certain hormones by the pituitary gland or the testicles can lead to abnormal sperm production.
• Sexual dysfunction: This encompasses problems with erection and ejaculation, and can play a role in male factor infertility.

Treatment for male infertility

Often, the exact cause of male infertility can’t be pinpointed. However, even if your doctors can’t determine the exact cause of infertility, your doctor can recommend treatments and procedures that will get you closer to a successful conception. 

Possible treatments to address male infertility include: 

• Surgery to correct an obstructed or damaged varicocele or vas deferens, or to reverse prior vasectomies.
• Sperm retrieval directly from the testicles or epididymis. 
• Antibiotics can cure reproductive tract infections and may restore fertility. 
• Medication can also improve fertility for individuals struggling with erectile dysfunction or premature ejaculation. Your doctor might recommend hormone treatments and medications in cases where infertility is caused by inadequate hormonal levels or distribution. 
• Assisted reproductive technology (ART) allows doctors to obtain and insert sperm into the female genital tract or through in vitro fertilization (IVF) or intracytoplasmic sperm injections (ICSI).