Male Infertility

Overview, Causes, & Risk Factors

Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Male infertility means the male is unable to impregnate the female because of male factors.

What is going on in the body?

The inability to get pregnant may be caused by conditions in either partner. It is estimated that 30% of infertility is caused by male factors. An additional 30% is caused by female factors. The remaining 40% is caused by a combination of female and male factors. Male infertility may be caused by many diseases, conditions, and other factors. Situations that raise the temperature in the testicles can interfere with normal sperm production.

What are the causes and risks of the condition?

There are many male factors that can make a couple unable to become pregnant. These may include conditions such as the following:

diabetic neuropathy, in which nerve damage causes problems with erection or ejaculation

extreme obesity

hormone imbalances, such as hypothyroidism

hypogonadism, a condition in which the testes fail to develop normally

inherited conditions that impair the ability to produce sperm, such as Down syndrome

testicular torsion, a condition in which the blood supply to the testicle is cut off

undescended testicles, a condition in which the testes fail to drop into the scrotum

varicocele, a group of enlarged veins inside the scrotum

Diseases also can be a factor in infertility, for example:

autoimmune disorders, which can cause the body to produce antibodies that attack sperm

liver disease

sickle cell anemia

kidney disease

genital infections such as Neisseria gonorrhoeae\ bacteria. The infection is usually acquired through sexual contact. ',CAPTION,'Gonorrhea in Males');" onmouseout="return nd();">gonorrhea and genital herpes

infections of the reproductive organs, such as prostatitis and epididymitis

infectious diseases, including mumps

Additional factors in infertility include the following:

certain medications, such as cimetidine and phenytoin

certain supplements, such as anabolic steroids

chemotherapy used for cancer

diet low in folic acid or low in lycopene, which is found in plants such as tomatoes

excessive exercise, which lowers testosterone levels and decreases sperm production

exposure to diethylstilbestrol, also known as DES, as an infant in utero

exposure to toxins such as lead, mercury, or pesticides

frequent hot baths or use of hot tubs

injury to the testicles

low sperm count, poor sperm quality, and poor movement of sperm

radiation therapy

recreational drugs, such as alcohol, methadone, and marijuana

sexual problems, such as erectile dysfunction and premature ejaculation

side effects of treatments for testicular cancer or prostate cancer

surgery of the reproductive system, such as transurethral resection of the prostate

vasectomy, a surgical procedure to tie off the sperm-carrying tubes

wearing tight-fitting pants and underwear

work that requires prolonged sitting, which increases the temperature in the scrotum

A recent study has found that baby boys who wear diapers lined with plastic have significantly higher temperatures inside the testicles. The researchers suggest that disposable diapers may have contributed to the increase in male infertility over the past 25 years.

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Symptoms & Signs

What are the signs and symptoms of the condition?

Male infertility occurs when the man's partner does not conceive after one year of attempting to become pregnant. Other signs and symptoms depend on the underlying cause of the man's infertility.

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Diagnosis & Tests

How is the condition diagnosed?

The diagnosis of infertility begins with a medical history and physical exam. The provider may order blood tests to look for hormone imbalances or disease. A semen sample may be needed. The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed.

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Prevention & Expectations

What can be done to prevent the condition?

Some cases of male infertility may be avoided by doing the following:

Avoid drugs and medications known to cause fertility problems.

Avoid excessive exercise.

Avoid exposure to environmental hazards such as pesticides.

Avoid frequent hot baths or use of hot tubs.

Avoid tight underwear or pants.

Eat a diet with adequate folic acid.

Get early treatment for sexually transmitted diseases.

Have regular physical examinations to detect early signs of infections or abnormalities.

Keep diseases, such as diabetes and hypothyroidism, under control.

Practice safer sex to avoid sexually transmitted diseases.

Take a lycopene supplement.

Wear protection over the scrotum during athletic activities.

Although more research needs to be done, parents may want to consider alternatives to disposable diapers for male infants.

What are the long-term effects of the condition?

Male infertility can create tension in a couple's relationship. Sexual relations may become less pleasurable. Fertility evaluations can be expensive. Eventually, 85% of couples find a cause for their inability to conceive. However, some couples never become pregnant, even with the newest treatments. Adoption may be the best choice in some cases.

What are the risks to others?

Male infertility is not contagious. However, male infertility can be caused by a sexually-transmitted disease, which may be transmitted to sexual partners.

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Treatment & Monitoring

What are the treatments for the condition?

Treatment of male infertility focuses on the underlying cause. Without treatment, 15% to 20% of infertile couples will eventually get pregnant. Treatment for a male with infertility may include:

avoiding extended periods of time in hot baths and hot tubs

eating a healthy diet and exercising in moderation

having a varicocele surgically repaired

having vasectomy reversal surgery, which reconnects the tubes carrying sperm from the testes

learning about the best times to conceive

making lifestyle changes, such as smoking cessation and limiting intake of alcohol

taking antibiotics for any diagnosed infection

taking hormone therapy

treating erectile dysfunction with counseling, medication, or surgery

wearing loose-fitting underwear, such as boxer shorts

If these treatments don't work, other means of fertilization may be considered, such as:

artificial insemination. This involves placing sperm directly in the cervix or uterus.

intracytoplasmic sperm injection. This involves placing individual sperm cells directly inside the woman's eggs.

in vitro fertilization. This involves fertilizing the egg outside the womb and then returning it to the uterus.

What are the side effects of the treatments?

Surgery can cause bleeding, infection, and allergic reactions to anesthesia. In vitro fertilization increases the chance of having a multiple pregnancy, such as twins. Antibiotics and other medications may cause stomach upset, diarrhea, or an allergic reaction.

What happens after treatment for the condition?

Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

How is the condition monitored?

The man can monitor his own ability to impregnate a woman. Any new or worsening symptoms should be reported to the healthcare provider.

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Attribution

Author:Gail Hendrickson, RN, BS
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:11/29/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/05/01

Sources

The Merck Manual of Medical Information, Home edition, 1997
Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000