Up to 15 percent of couples are infertile. This means they aren't able to conceive a child even though they've had frequent, unprotected sexual intercourse for a year or longer. In up to half of these couples, male infertility plays a role.
Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.Not being able to conceive a child can be stressful and frustrating, but a number of male infertility treatments are available.
The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.
Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:
- Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Recurrent respiratory infections
- Inability to smell
- Abnormal breast growth (gynecomastia)
- Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
- Having 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)
Male fertility is a complex process. To get your partner pregnant, the following must occur:
- You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
- Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
- There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner's egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
- Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner's egg.
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
- Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
- Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
- Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
- Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
- Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.
- Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
- Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
- Tobacco smoking. Men who smoke may have a lower sperm count than do those who don't smoke. Secondhand smoke also may affect male fertility.
- Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
- Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Infertility can be stressful for both you and your partner. Complications of male infertility can include:
- Surgery or other procedures to treat an underlying cause of low sperm count or other reproductive problems
- Expensive and involved reproductive techniques
- Stress and relationship difficulties related to the inability to have a child
Many types of male infertility aren't preventable. However, you can avoid some known causes of male infertility. For example:
- Don't smoke.
- Limit or abstain from alcohol.
- Steer clear of illicit drugs.
- Keep the weight off.
- Don't get a vasectomy.
- Avoid things that lead to prolonged heat for the testicles.
- Reduce stress.
- Avoid exposure to pesticides, heavy metals and other toxins.
When to see a doctor
See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:
- Have erection or ejaculation problems, low sex drive, or other problems with sexual function
- Have pain, discomfort, a lump or swelling in the testicle area
- Have a history of testicle, prostate or sexual problems
- Have had groin, testicle, penis or scrotum surgery