Male Infertility: Symptoms, Causes, and Treatment

A man is considered infertile if he is unable to impregnate a woman after about a year of longer of engaging in frequent unprotected sexual intercourse. Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Also, chronic health problems, injuries, lifestyle choices and other factors can play a role in causing infertility in men.

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Male infertility symptoms

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes symptoms.

Symptoms associated with infertility include:

  • Pain, swelling or a lump in the testicle area
  • Problems with sexual functions such as difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
  • Persistent respiratory infections
  • Having a low sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
  • Inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or hormonal abnormality

Causes of Infertility in Men

Male fertility is a complex process. To get your partner pregnant, the following must occur:

  • You must produce healthy sperm: This involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain production of sperm.
  • Sperm have to be carried into the semen:Once sperm are formed in the testicles, delicate tubes transport them until they blend with semen and are ejaculated out of the penis.
  • There needs to be enough sperm in the semen:If your sperm count (number of sperm in your semen) is low, it reduces the chances that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
  • Sperm must be functional and able to move:If the motility or function of your sperm is irregular, the sperm may not be able to reach or penetrate your partner’s egg.

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Medical causes

Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:

  • Varicocele:This is the most common cause of infertility in men, though it is reversible. A varicocele is a swelling of the veins that drain the testicle. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles can reduce quality of the sperm. The sperm numbers and function can improve if varicocele is treated, and may also possibly improve results when using assisted reproductive techniques such as in-vitro fertilization.
  • Infection:Some infections can inhibit sperm production or cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result to damage in testicle, most often sperm can still be retrieved.
  • Ejaculation issues:Reversing ejaculation occurs when semen enters the bladder during orgasm instead of coming out from the tip of the penis. Various health conditions can trigger retrograde ejaculation, including spinal injuries, some medications, diabetes, and surgery of the bladder, prostate or urethra.

Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.

  • Tumors:Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
  • Undescended testicles.In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
  • Antibodies that attack sperm:Anti-sperm antibodies are immune system cells that wrongly identify sperm as dangerous invaders and attempt to eliminate them.
  • Hormone imbalances.Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
  • Chromosome defects:Inherited disorders such as Klinefelter’s syndrome, in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
  • Problems with sexual intercourse:These can include trouble keeping or maintaining an erection appropriate for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that impede sex.
  • Defects of tubules that transport sperm:Many different tubes transport sperm. They may get blocked due to various causes such as inadvertent injury from surgery, infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can happen at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
  • Prior surgeries:Certain surgeries may prevent you from having sperm when you ejaculate. These surgeries include prostate surgeries, vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.
  • Celiac disease:This is a digestive disorder caused by sensitivity to gluten. Celiac disease can cause male infertility. Fertility may be achieved after implementing a gluten-free diet.
  • Certain medications:Some medications can damage sperm production. These may include long-term anabolic steroid use, testosterone replacement therapy, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications.

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Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

  • Industrial chemicals:Lengthy exposure to chemicals such as lead, herbicides, benzenes, xylene, toluene, organic solvents, painting materials, and pesticides may contribute to low sperm counts.
  • Heavy metal exposure:Exposure to lead or other heavy metals also may lead to infertility.
  • Radiation or X-rays:Exposure to radiation can affect sperm production, though it will often eventually return to normal. However, with high doses of radiation, sperm production can be permanently reduced.
  • Overheating the testicles.Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.

Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.

Health, lifestyle and other causes

Some other causes of male infertility include:

  • Illicit drug use:Anabolic steroids taken to stimulate muscle strength and growth can lead to the shrinkage of testicles and decrease in sperm production. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
  • Alcohol use:Drinking alcohol excessively can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
  • Tobacco smoking:Men who smoke may have a lower sperm count compared to those who don’t smoke. Secondhand smoke also may also affect male fertility.
  • Emotional stress:Stress can affect certain hormones required to produce sperm. Severe emotional stress, including problems with fertility, can affect your sperm count.
  • Weight:Obesity can damage fertility in numerous ways, including directly impacting sperm negatively, as well as causing hormone changes that reduce fertility in men.

When to see a doctor

See a doctor if you have been unable to impregnate a woman after a year of regular, unprotected intercourse or sooner if you have any of the following:

  • Have pain, lump, discomfort, or swelling in the testicle area
  • Have erection or ejaculation problems, low sex drive, or other problems with sexual function
  • Have a history of testicle, prostate or sexual problems
  • Have had groin, testicle, penis or scrotum surgery

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Risk factors

Risk factors linked to male infertility include:

  • Using alcohol
  • Using certain illicit drugs
  • Obese
  • Smoking tobacco
  • Overheating the testicles
  • Having a history of undescended testicles
  • Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer
  • Having an early vasectomy or major abdominal or pelvic surgery
  • Certain past or present infections
  • Exposure to toxins
  • Having experienced trauma to the testicles
  • Being born with a fertility disorder or having a blood relative with a fertility disorder
  • Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease

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  • Avoid smoking.
  • Limit or abstain from alcohol.
  • Avoid use of illicit drugs.
  • Avoid exposure to pesticides, heavy metals and other toxins.
  • Maintain a healthy weight.
  • Don’t get a vasectomy.
  • Avoid things that lead to lengthy heat for the testicles.
  • Reduce stress.


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