Many causes of male infertility, a factor in about half of couples struggling to conceive, are treatable. Identifying and treating male infertility often allows couples to achieve pregnancy without more aggressive infertility treatments, such as in vitro fertilization.
Treatment begins with counseling regarding sexual practices that may impair the chance for conception, including timing for intercourse and use of lubricants that can impair sperm survival.
Lifestyle changes may be a part of the treatment plan. Decreasing or eliminating the use of certain chemical substances that harm sperm may be recommended. A wide range of prescription and over-the-counter medications can affect sperm quality and quantity, as can excessive alcohol use, tobacco, marijuana, heroin and methadone.
When needed, assisted reproductive treatments can also be considered.
- Intrauterine insemination (IUI) involves depositing a large number of specially processed sperm into the uterus at the optimal point in the menstrual cycle.
- In vitro fertilization (IVF) involves harvesting eggs from the female partner and combining them with sperm in a carefully controlled laboratory procedure. Once an embryo or embryos form, they are transferred to the woman's uterus.
- Intracytoplasmic sperm injection (ICSI) involves injecting a single sperm into an egg. This is a highly specialized technique.
Causes of Male Infertility
There are many possible causes of male fertility issues. In some cases, more than one factor may be involved.
The most common cause of male infertility is a varicocele — a dilation or swelling of the veins that drain the testicle. It is possible to correct a varicocele with an outpatient surgical procedure. The success rate following treatment results in improvement in the vast majority of cases.
Abnormalities in hormone production, such as decreased testosterone levels, can lead to low sperm counts and lowered male fertility. Other hormones such as follicle stimulating hormone (FSH) and leutinizing hormone (LH) may also play a role. Treatment, through hormonal replacement therapy, can enhance libido and energy, and usually results in moderate pregnancy rates, even when sperm counts do not improve dramatically.
Ejaculatory dysfunction involves a man’s inability to ejaculate during sexual activity. In some men, the semen enters the bladder instead of going out through the urethra during ejaculation (called retrograde ejaculation). Causes include spinal cord injury, surgical side effects, medications and psychiatric factors. Ejaculatory dysfunction may or may not be associated with a loss of orgasm.
Ejaculatory dysfunction can be treated with medication or procedures to produce ejaculation. Sperm can then be used with assisted reproductive technologies, such as intrauterine insemination (IUI) or in vitro fertilization (IVF), to achieve fertilization and pregnancy.
Surgery and Injury
Previous surgeries may affect a man's fertility. Surgery in the groin, pelvis or abdominal area can damage nerves or structures necessary for ejaculation.
Testicular trauma or torsion may also create fertility issues. Testicular torsion is a condition in which the testicle twists on the cord that attaches it to the body. About 30 percent to 40 percent of men with a history of testicular torsion have an abnormal semen analysis.
Diseases such as diabetes mellitus or multiple sclerosis can impair potency as well as ejaculation.
Infections of the reproductive tract, although rare, also can affect male fertility. Bacteria can harm semen quality and can produce an obstruction within the tract, especially at the epididymis. Treatment with antibiotics may be prescribed if a man is found to have an infection or inflammation in any of the organs associated with sperm production or transportation.
The mumps virus, if contracted after puberty, can affect fertility. Damage to the testicles occurs in approximately 10 percent of men who develop mumps after puberty.
Genetic factors may be responsible for male infertility. Defects in specific genes may result in both male and female infertility. Other family members with fertility problems or genetic disorders, such as cystic fibrosis, may suggest a genetic cause.
Vasectomy, a surgical procedure designed to make a man sterile, involves cutting or blocking the tubes through which sperm pass into the ejaculate. Vasectomy reversal can result in return of sperm to the ejaculate in 50 percent to 95 percent of men.
In an abundance of caution, care and concern for our patients, staff and community, we are delaying fertility treatment starts until we have a greater sense of the degree of COVID-19 transmission in our region. We will closely follow ASRM and CDC recommendations as they become available.