Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant.
About 13 out of 100 couples can’t get pregnant with unprotected sex. There are many causes for infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery.
The man’s body makes tiny cells called sperm. During sex, ejaculation normally delivers the sperm into the woman’s body.
The male reproductive system makes, stores, and transports sperm. Chemicals in your body called hormones control this. Sperm and male sex hormone (testosterone) are made in the 2 testicles. The testicles are in the scrotum, a sac of skin below the penis. When the sperm leave the testicles, they go into a tube behind each testicle. This tube is called the epididymis.
Just before ejaculation, the sperm go from the epididymis into another set of tubes. These tubes are called the vas deferens. Each vas deferens leads from the epididymis to behind your bladder in the pelvis. There each vas deferens joins the ejaculatory duct from the seminal vesicle. When you ejaculate, the sperm mix with fluid from the prostate and seminal vesicles. This forms semen. Semen then travels through the urethra and out of the penis.
Male fertility depends on your body making normal sperm and delivering them. The sperm go into the female partner’s vagina. The sperm travel through her cervix into her uterus to her fallopian tubes. There, if a sperm and egg meet, fertilization happens.
The system only works when genes, hormone levels and environmental conditions are right.
Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility. These are the main causes of male infertility:
The types of shoulder surgery procedures include:
The most common problems are with making and growing sperm. Sperm may:
Sperm problems can be from traits you’re born with. Lifestyle choices can lower sperm numbers. Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone problems (such as low testosterone).
Damage to the reproductive system can cause low or no sperm. About 4 out of every 10 men with total lack of sperm (azoospermia) have an obstruction (blockage) within the tubes the sperm travel through. A birth defect or a problem such as an infection can cause a blockage.
Varicoceles are swollen veins in the scrotum. They’re found in 16 out of 100 of all men. They are more common in infertile men (40 out of 100). They harm sperm growth by blocking proper blood drainage. It may be that varicoceles cause blood to flow back into your scrotum from your belly. The testicles are then too warm for making sperm. This can cause low sperm numbers.
For more information please refer to the Varicoceles information page.
Retrograde ejaculation is when semen goes backwards in the body. They go into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm (climax). Semen may have normal sperm, but the semen is not released from the penis, so it cannot reach the vagina.
Retrograde ejaculation can be caused by surgery, medications or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or “dry” ejaculation.
Sometimes a man’s body makes antibodies that attack his own sperm. Antibodies are most often made because of injury, surgery or infection. They keep sperm from moving and working normally. We don’t know yet exactly how antibodies lower fertility. We do know they can make it hard for sperm to swim to the fallopian tube and enter an egg. This is not a common cause of male infertility.
Sometimes the tubes through which sperm travel can be blocked. Repeated infections, surgery (such as vasectomy), swelling or developmental defects can cause blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can’t leave the body during ejaculation.
Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth.
Sperm carry half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.
Certain medications can change sperm production, function and delivery. These medications are most often given to treat health problems like:
Causes of male fertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis starts with a full history and physical exam. Your health care provider may also want to do blood work and semen tests.
Your health care provider will take your health and surgical histories. Your provider will want to know about anything that might lower your fertility. These might include defects in your reproductive system, low hormone levels, sickness or accidents.
Your provider will ask about childhood illnesses, current health problems, or medications that might harm sperm production. Such things as mumps, diabetes and steroids may affect fertility. Your provider will also ask about your use of alcohol, tobacco, marijuana and other recreational drugs. He or she will ask if you’ve been exposed to radiation, heavy metals or pesticides. Heavy metals are an exposure issue (e.g. mercury, lead arsenic). All of these can affect fertility.
Your health care provider will learn how your body works during sex. He or she will want to know about you and your partner’s efforts to get pregnant. For example, your healthcare provider may ask if you’ve had trouble with erections.
The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor will look for varicoceles. They can be found easily with a physical exam.
Shoulder surgery will cure your condition and reduce your symptoms so you can lead an active and normal life. But it cannot prevent future damage to your shoulder. You can help prevent further shoulder damage by:
Your health care provider will study your sperm volume, count, concentration, movement (“motility”), and structure. The results of the semen analysis tests tells about your ability to conceive (start a pregnancy).
Even if the semen test shows low sperm numbers or no sperm, it may not mean you are permanently infertile. It may just show there’s a problem with the growth or delivery of sperm. More testing may be needed. Even if no sperm are seen on a semen analysis, then treatment may be possible.
Your health care provider may order a transrectal ultrasound. Ultrasound uses sound waves bouncing off an organ to get a picture of the organ. A probe is placed in the rectum. It beams sound waves to the nearby ejaculatory ducts. The health care provider can see if structures such as the ejaculatory duct or seminal vesicles are poorly formed or blocked.
If a semen test shows a very low number of sperm or no sperm you may need a testicular biopsy. This test can be done with general or local anesthesia. A small cut is made in the scrotum. It can also be done in a clinic using, a needle through the numbed scrotal skin. In either case, a small piece of tissue from each testicle is removed and studied under a microscope. The biopsy serves 2 purposes. It helps find the cause of infertility and it can collect sperm for use in assisted reproduction (such as in vitro fertilization; IVF).
The health care provider may check your hormones. This is to learn how well your testicles make sperm. It can also rule out major health problems. For example, follicle-stimulating hormone (FSH) is the pituitary hormone that tells the testicles to make sperm. High levels may mean your pituitary gland is trying to get the testicles to make sperm, but they won’t.
Treatment depends on what’s causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into 3 categories:
Anejaculation is when there’s no semen fluid released with a man’s sexual climax. It’s not common, but can be caused by:
Drugs are often tried first to treat this condition. If they fail, there are several option. Penile vibratory stimulation (PVS) or Rectal probe electroejaculation (RPE, better known as electroejaculation or EEJ) may induce ejaculation. Sperm may also be retrieved directly from the testicle with a needle (Testicular Sperm Aspiration)
Rectal probe electroejaculation is most often done under anesthesia. This is true except in men with a damaged spinal cord. RPE retrieves sperm in 90 out of 100 men who have it done. Many sperm are collected with this method. But sperm movement and shape may still lower fertility.
Assisted reproductive techniques like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are of great value to men with anejaculation because sperm may be weak in men with impaired sperm (cells) and semen (fluid) transport out of the body, the underlying problem with anejaculation.
Genital tract infection is rarely linked to infertility. It’s only found in about 2 out of 100 men with fertility problems. In those cases, the problem is often diagnosed from a semen test. In the test, white blood cells are found. White blood cells make too much “reactive oxygen species” (ROS). This can damage sperm, lowering the chances of sperm being able to fertilize an egg. For example, a severe infection of the epididymis and testes may cause testicular shrinking and epididymal duct blockage. The infection doesn’t have to be sudden to cause problems.
Antibiotics are often given for full-blown infections. But they’re not used for lesser inflammations. Some antibiotics can occasionally harm sperm production or function. Non-steroidal anti-inflammatories (such as ibuprofen) are often used instead.
Inflammation from causes other than infection can also affect fertility. For example, chronic prostatitis, in rare cases, can also block the ejaculatory ducts.
Hyperprolactinemia is when the pituitary gland makes too much of the hormone prolactin. It’s a factor in infertility and erectile dysfunction. Treatment depends on what’s causing the increase. Drugs or less commonly surgery may be used to treat tumors in the pituitary if present.
Hypogonadotropic hypogonadism is when the testicles don’t make sperm due to poor stimulation by the pituitary hormones. This is due to a problem in the pituitary or hypothalamus. It’s the cause of a small percentage of infertility in men. It can exist from birth,typically being apparent when the young man is supposed to go through puberty (“congenital”). Or it can show up later (“acquired”).
The congenital form, known also as Kallmann’s syndrome, is caused by lower amounts of gonadotropin-releasing hormone (GnRH). GnRH is a hormone made by the hypothalamus. The acquired form can be triggered by other health issues such as:
If hypogonadotropic hypogonadism is suspected, your health care provider may want you to have an MRI. This will show a picture of your pituitary gland. You will also have a blood test to check prolactin levels. Together, an MRI and blood test can evaluate for pituitary tumors. If there are high levels of prolactin but no tumor on the pituitary gland, your provider may try to lower your prolactin first. Gonadotropin replacement therapy would be the next step. During treatment, blood testosterone levels and semen will be checked. Chances for pregnancy are very good. The sperm resulting from this treatment are normal.
Some men are born with a genetic condition that may be new (not present in other family members) or hereditary (passed from mother and/or father), showing up first in the affected patient. The known causes of genetic abnormalities are most commonly detected in men with no sperm in the ejaculate (azoospermia), where the condition affects sperm production (e.g., Klinefelter syndrome – where an extra chromosome is present in the man, or Y chromosome microdeletions – where a small segment of genetic tissue is missing.). Genetic conditions can also affect the development of the male tract that carries sperm, resulting in failure of formation of the tubes that are supposed to carry sperm.
Retrograde ejaculation, semen flowing back instead of going out the penis, has many causes. It can be caused by:
Retrograde ejaculation is found by checking your urine for sperm. This is done under a microscope right after ejaculation. Drugs can be used to correct retrograde ejaculation.
It is often treated first with over-the-counter medications like Sudafed®. If medications don’t work and you need assisted reproductive techniques (ARTs), your health care provider may try to collect sperm from your bladder after ejaculation.