Male infertility is when a health problem in the male makes it harder or impossible for a couple to conceive. Many health issues — from low sperm quality to blockages in the genitals to genetic conditions — can affect male fertility.
If a couple can’t get pregnant after one year of trying, doctors call this infertility. Men contribute to infertility about 50% of the time, according to the American Urological Association. In 20% of cases, male infertility is the sole cause.
Finding out whether a woman or man is infertile or if both partners have fertility challenges requires testing.
What Causes Male Infertility?
Many health problems can cause infertility in men. The most common causes are low sperm counts and poor semen quality.
Causes of male infertility include:
- Blockage in the male reproductive tract — A blockage in the tube running from the scrotum to the end of the penis.
- Low sperm count — Too little sperm or no sperm.
- Poor sperm quality — When the sperm don’t fully grow, take on odd shapes, or don’t move well.
- Retrograde ejaculation — When semen goes backward into the bladder instead of out of the penis. This happens when the entrance to the bladder doesn’t close properly during orgasm.
- Sexual dysfunction — Premature ejaculation or erectile dysfunction can contribute to infertility in men.
- Varicoceles — These are swollen veins in the scrotum. These can increase blood supply, which adds heat. Heat can affect the sperm-making process.
Sometimes, why these problems happen is unclear.
In other cases, they happen because of:
- Autoimmune problems — These diseases can cause the immune system to attack the sperm.
- Chronic diseases — Diabetes and obesity can affect how the body produces sperm or cause sexual dysfunction.
- Congenital disabilities — Can obstruct the genital tract.
- Genetic disorders — Klinefelter syndrome, Kallmann syndrome, Kartagener syndrome, and other genetic disorders can cause hormone imbalances. Cystic fibrosis can prevent the tubes that carry sperm from forming properly.
- Hormone imbalances — Hormone levels that are too low or too high. Various hormones work together in the body to create and release sperm.
- Infections — Current or previous infections (including childhood infections) can cause blockages or interfere with the sperm-making process.
- Lifestyle choices — Smoking cigarettes, drinking alcohol, and substances like cannabis can contribute to sperm disorders.
- Medications and supplements — Side effects of testosterone supplements, opioids, cancer drugs, and many other medications can reduce male fertility.
- Previous surgeries — Scarring from previous surgeries can lead to blockages and retrograde ejaculation.
- Tumors or cysts — These can cause blockages in the male reproductive tract or affect hormone production.
How Do Doctors Diagnose Male Fertility Challenges?
If a couple can’t conceive for more than a year, they should see a doctor. Most fertility doctors will work with each person in the couple trying to conceive. A fertility doctor may see both partners at the same time or separately.
They ask about medical history and do physical exams and tests for both partners. That’s because whether male or female infertility is playing a role (or both are) is usually unclear.
To assess whether male infertility is playing a role, the doctor will ask about the following:
- Any chronic health conditions.
- How long the couple has been having unprotected sex.
- How often and when (during a woman’s cycle) the couple is having sex.
- Lifestyle, including diet, exercise, and use of alcohol and other substances.
- Medications.
- Previous diagnoses.
- Previous surgeries.
Tests for male infertility
The first step in assessing male fertility is semen analysis. The man ejaculates into a sterile container. He then brings the sample to the clinic for testing within one hour.
The patient produces a sperm sample in a private room at the clinic or at a home near the clinic.
The semen analysis can reveal:
- How much live sperm a man produces.
- The size and shape of the sperm.
- How well the sperm move.
- Signs of infection (white blood cells in the semen).
- The semen’s acidity, which can affect sperm quality.
The doctor usually asks men to take this test a second time about a month later. Testing twice increases the accuracy of the results.
Doctors may perform other tests to tell if a man is infertile.
These can include:
- Blood tests to check hormone levels.
- Imaging tests (like MRIs or ultrasounds) to look for blockages.
- A biopsy to retrieve semen from the testicles. If there’s no sperm in the ejaculate, the biopsy sample can assess whether the sperm is developing correctly.
- Tests to look for genetic problems that can cause male infertility.
- Physical exams to look for varicoceles or smaller testicles. Small testicles are a possible sign of Klinefelter syndrome or can happen with testosterone supplements, both of which lower male fertility.
What Are Treatments for Male Infertility?
The treatment for male infertility often depends on the cause. Even if the cause remains unclear, however, treatments like artificial insemination or in vitro fertilization (IVF) may lead to a viable pregnancy.
Treatments to fix male infertility can include:
- Hormone therapies — This can help if testing shows hormone imbalances.
- Intracytoplasmic sperm injection — This procedure injects the sperm directly into the egg. It can increase the success of IVF in some cases.
- Intrauterine insemination — A doctor injects sperm into the uterus through a tube.
- In vitro fertilization — Retrieving one or more eggs from a woman and fertilizing them with sperm in a petri dish. A doctor will insert one or more resulting embryos into the uterus.
- Other medications — Medication can help to close the opening of the bladder for retrograde ejaculation. Medication can also help with erectile problems.
- Stopping or switching medications — This can help if medications are contributing to male infertility.
- Sperm retrieval — Taking sperm directly from the testicles for use in intrauterine insemination (IUI) or IVF.
- Surgery — Surgery can treat varicoceles or blockages.
Male infertility treatments don’t always work. In these cases, couples may consider getting pregnant using donor sperm.
What Lifestyle Changes Can Improve Male Fertility?
Men can increase their sperm count and quality by:
- Avoiding heat from tight clothing, saunas, hot baths, and hot tubs.
- Eating a healthy diet and exercising regularly.
- Getting enough sleep.
- Losing weight, if obese.
- Lowering stress levels through exercise, meditation, reducing one’s workload, or other techniques.
- Quitting smoking.
- Reducing alcohol intake.
- Stopping cannabis usage and the use of other substances.
Do supplements help male infertility?
Some studies say supplements, such as vitamin C, vitamin E, zinc, fish oil, and others, can help. However, other studies didn’t find that supplements helped male infertility.
Though whether supplements help is still unclear, some doctors recommend them because they’re low-cost and low-risk.
Editor's Note: This article was originally published on , and was last reviewed on .