Male infertility - causes and treatments

Infertility denotes a situation where a sexually active couple who are not using any contraception are unable to become pregnant despite the fact that they have been trying for a year or more. In these situations, the male partner will be the problem in about 20% of cases and for about 30% of infertile couples, the problem will be with both partners; the man contributes to about 50% of all infertility.

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Symptoms of male infertility

Provided that there is no obvious sign of sexual dysfunction, problems with achieving erections, hormonal problems and ejaculation, infertility is largely an invisible problem and it is likely that it will remain undiscovered until a man is tested when infertility problems arise

Diagnosis of male infertility

If you and your partner have been trying to become pregnant for a year or more, it may be time to seek advice from your GP.

Your doctor will need to ask how long you have been trying for a family, ask if there have been any problems sexually. Your medical history and lifestyle will be relevant as may some of the following questions:

Whether there is a history of sexually transmitted infections
Is there a history of any infections or conditions which may affect fertility
Whether you are stressed
Are there any work issues or factors which may be contributing to the problem
Are you on any regular medication and if so, which medication
Have you had children with another partner?
Do you smoke
Do you regularly drink heavily?

Your doctor will perform an examination and order some tests. The tests will include a semen test which can be collected in the clinic or at home. The semen will be tested for sperm count, the quality of the sperm and the mobility of the sperm. If there are any problems the test will be repeated in 12 weeks and if the problem persists you will be referred to a fertility specialist

If you are having trouble achieving or maintaining an erection long enough to have sexual intercourse, your doctor may request a blood test to check your hormone levels. The GP may also test for diabetes as this condition can cause erectile dysfunction

Further tests may include:

Taking a urine sample to be checked for retrograde ejaculation; this is a condition whereby semen is ejaculated ‘backwards’ into the bladder instead of out through the urethra
If you are not producing any sperm, your GP may request an ultrasound scan of the testes
Testing for any genetic conditions which may affect sperm production

It may be that an underlying health condition is causing fertility issues; if the condition is treated the result may be to restore a man’s fertility

Causes of male infertility

Male infertility has many possible causes and these can be grouped as follows:

Abnormal function of sperm - this is probably the most common cause of infertility. It encompasses scenarios which include a low sperm count, slow-moving sperm and misshapen sperm
Absence of sperm in the semen - this condition is called obstructive azoospermia. It is caused by blockages in the tubes (seminal ducts) from the testicles to the urethra
Testicle problems - these many include abnormal growth or development of the testicles as well as damage from infections and trauma
Exposure to toxins which may damage the testicles such as radiation or chemicals
Problems with pathways for sperm travel within the male reproductive organs. This may include blocked tubes, varicose veins in the testicles, infections of the genitals or ejaculation issues
Problems with hormone levels - low levels of thyroid hormones and testosterone (specifically called hypogonadism) can affect sperm production
Inherited (genetics) disorders - for example, cystic fibrosis and Klinefelter’s syndrome
General illnesses - kidney disease, malnutrition and cirrhosis of the liver
Medication and drugs - these can include anabolic steroids, psychiatric medication and alcohol
Ejaculation disorders - these include erectile dysfunction, retrograde ejaculation, delayed ejaculation and anorgasmia

As many as 50% of infertile men do not exhibit anything which may be causing the condition. Apart from the fact that an infertile man may wish to become a father, infertility is largely a harmless issue. However, there are approximately 1% of infertile men whose infertility is as a result of a serious medical problem such as hormonal problems, infections or tumours and these issues must be addressed

Genetics and male infertility

Some genetic problems can harm the production of sperm or block the flow of sperm. The following genetic conditions can cause infertility by affecting the way that sperm is produced:

Y chromosome deletions - with this condition a male is born with genetic material that is responsible for sperm production is missing from the Y chromosome
Klinefelter syndrome - in this condition the man is born with an extra X chromosome. This results in problems in the testicles and the vast majority of sufferers are infertile
Other genetic problems - people born with Down's syndrome can be fertile but have a reduced rate of fertility

How can I boost my fertility?

If you have been trying for a baby for less than a year there are some things that you can try that may increase your chance of conceiving naturally

Timing - having intercourse every 2 to 3 days will maximise the chance of conceiving; this is because it ensures that you have sex during the female's fertile period. It is advised not to use lubricants as these can affect the quality of the sperm
Lifestyle and diet - stop smoking and ensure that you do not exceed the recommended number of units of alcohol per week. Be aware that some recreational drugs can affect fertility
Keep the scrotum cool - the testicles are stored in a bad (scrotum) which is outside the body. This is to keep sperm cooler because if they become too warm it can affect their quality. Activities to avoid include driving for long periods of time, working in hot conditions, using laptops and having hot baths or saunas. Loose-fitting underwear is recommended
Check your medication - Some medication can affect sperm production and ejaculation so check with your pharmacist or GP
Work safe - make sure your working environment is safe as some conditions may affect fertility. These include excessive heat, chemicals, pesticides and x-rays. Consult with your employer.
Keep the stress down - this may sound easier said than done but trying to conceive in itself can be stressful and this, in turn, can have a negative effect on libido, relationships and mental health

Treatment for male infertility

Treatment for male infertility is wholly dependent on its cause:

Abnormal sperm function - there are a number of ways to help improve sperm function, they include regular exercise, relax and minimise stress, and ensure you have all the nutrients you need by having a good diet and taking supplements where needed
Absence of sperm in the semen - this can be treated with surgery to unblock the seminal ducts
When there is damage to the testicles it will depend on the extent of the damage and the result of that damage. It may be that there is no treatment that will reverse the damage
If any pathways which carry sperm from the testes to the outside are blocked then surgery may be an option
If there are problems with hormone levels then hormone replacement therapy will help
If medication and drugs are causing infertility then alternatives must be found for the medication and the use of recreational drugs must stop
Ejaculation problems may be assisted with medication or counselling
If the general disease is causing infertility problems then once the disease is treated the fertility problems may disappear

Conclusion

It may be that despite having had a myriad of tests that no cause for the lack of falling pregnant can be found and it is likely that a couple just need more time to conceive

There is likely to be a great deal of stress associated with the inability to become pregnant. There are many ways of managing stress that your health professional will be able to help you with. Counselling and support groups may be the best approach