What is male infertility?

Infertility is a disease of the reproductive system. It makes a person unable to have children. It can affect a man, a woman, or both. Male infertility means that a man has a problem with his reproductive system. It means you can't start a pregnancy with your female partner.

Gender words are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

What causes male infertility?

Natural male reproduction depends on several things.

You must be able to:

• Make healthy sperm that can fertilize the egg
• Have an erection and ejaculate so the sperm reaches the egg

Problems with either of these may mean you have infertility. Below are some of the main causes of male infertility.

Sperm disorders

Problems with making healthy sperm are the most common causes of male infertility. Sperm may be immature, abnormally shaped, or unable to swim. In some cases, you may not have enough sperm. Or you may not make any sperm. This problem may be caused by many different conditions, including:

• Infections or inflammatory conditions. One example is infection with the mumps virus after puberty.
• Hormone or pituitary gland problems
• Immune problems in which you make antibodies against your own sperm
• Environmental and lifestyle factors. These include tobacco use, heavy alcohol use, marijuana or steroid use, or exposure to toxins.
• Genetic diseases, such as cystic fibrosis or hemochromatosis

Structural problems

Anything that blocks the genital tract can stop the flow of semen. This could be a genetic or birth defect. Infection or inflammation from a sexually transmitted disease can also block semen. Other causes include scar tissue from surgery or twisted, swollen veins in the scrotum.

Other factors

Other factors may include erectile dysfunction or premature ejaculation. These include liver or kidney disease, or treatment for seizure disorders.

Who is at risk for male infertility?

You may be more likely to have male infertility if you have had:

• Past inflammation of the prostate or past genital infections
• Injury to or twisting (torsion) of the testicles
• Early or late puberty
• Genital exposure to high temperatures
• Hernia repair
• Undescended testicles
• Diagnosed immune condition in which you make antibodies against your own sperm
• Genetic conditions, such as cystic fibrosis or hemochromatosis

You may also be at risk if you take certain prescription medicines. These include medicines for ulcers, psoriasis, depression, and high blood pressure.

What are the symptoms of male infertility?

You may have male infertility if your female partner has not become pregnant after you have tried for one year. This means one year of regular sex without any birth control.

Your healthcare provider will test both you and your partner to find the cause of infertility.

How is male infertility diagnosed?

Your healthcare provider will review your health history and do a physical exam. Although it is appropriate for the initial infertility evaluation to be done by your primary care physician, if the test results are abnormal, you should be referred to a fertility specialist.

Other tests for male infertility may include:

• Sperm count (semen analysis). At least 2 semen samples are taken on separate days. Your provider will check the semen and sperm for many things. These include how much semen you make, how uniform it is, and how acidic it is. Your provider will also look at how many sperm you make, how well they move, and what shape they are.
• Blood tests. Your provider may use blood tests to check hormone levels and rule out other problems.
• Other tests. Your provider does these tests to find the cause of sperm defects or health problems of the male reproductive system. For instance, imaging tests, such as an ultrasound, may be used to look at your testicles, blood vessels, and structures inside the scrotum.
• Testicular biopsy. If semen analysis shows that you have only a few sperm or no sperm, your provider may remove a small piece of tissue (biopsy) from each testicle. The sample will be checked under a microscope.

How is male infertility treated?

Treatment depends on what is causing your infertility.

Fertility help

This treatment involves helping your partner get pregnant. It may be through:

• Artificial insemination. This method puts many healthy sperm at the entrance of the cervix or right into the partner's uterus. The sperm can then make their way to the fallopian tubes.
• IVF, GIFT, and other methods. In vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) work like artificial insemination. Your provider collects your sperm. Then your provider mixes your partner’s eggs with a lot of high-quality sperm. Your provider may mix the eggs and sperm in the lab or in your partner’s fallopian tube.
• Intracytoplasmic sperm injection. Your provider injects a single sperm into an egg. Fertilization then takes place under a microscope. Your provider puts the fertilized egg in your partner’s uterus.

Medicine

Hormone treatment may help you if you have a hormone disorder causing your infertility. Hormone imbalances can affect how sperm develop. They may be caused by a problem in how the hypothalamus, pituitary gland, and testes interact. Treatment may include gonadotropin therapy or antibiotics.

Surgery

Your provider may use surgery to fix problems that keep sperm from being made, matured, or ejaculated. Surgery to remove swollen veins in the scrotum (varicocele) can sometimes improve the quality of sperm. You may need surgery to reconnect or open blocked tubes that allow sperm to be ejaculated.

Check with your healthcare provider about any questions or concerns you have about your condition. Male infertility can cause emotional stress. Don't hesitate to ask about professional counseling services to help you and your partner manage this condition.

Key points about male infertility

• Male infertility means a man is not able to start a pregnancy with his female partner after trying for 1 year with regular sex and no birth control.
• Male infertility can have many causes. You may not make enough sperm or healthy sperm. You may have a genetic problem, such as cystic fibrosis. You may have a blockage in your genital tract.
• You may be more likely to have male infertility if you have had genital infections, injury to your testicles, or early or late puberty.
• Treatment depends on what is causing your infertility. Treatments include artificial insemination, medicines, and surgery.
• Infertility can cause stress in a relationship. Ask your healthcare provider about counseling if you and your partner need support.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.

Male Reproductive Anatomy

The reproductive system is the part of the body involved in sexual function. Below are parts of the reproductive anatomy for people who are assigned male at birth.

Penis. This is the external male reproductive organ. The penis is made up of spongy tissue that holds blood. When the penis is soft, blood flows in and out of the tissue. During sexual excitement, extra blood flows into the tissue. The extra blood makes the tissue swell. The penis then becomes hard (erect). This makes it firm enough to have sex.

Urethra. This transports urine and semen. When you have an orgasm, fluid called semen is ejaculated out of the urethra.

Testicles (testes). These are glands that make sperm (reproductive cells) and hormones.

Scrotum. This is the skin-covered sac that hangs on the outside of the body. The scrotum contains the testes.

Epididymis. This is a coiled tube that holds sperm while they mature.

Vas deferens. This a coiled tube that carries sperm from the epididymis to the penis. It is also called the sperm duct.

Seminal vesicles. These are two glands that sit behind the bladder, which is the organ that holds urine. The seminal vesicles secrete a substance that nourishes sperm cells.

Prostate. This gland makes a fluid that is part of semen.

After sexual arousal, sperm move away from the epididymis through the vas deferens. Along the way, the sperm mix with fluids made by the seminal vesicles and prostate gland to form semen. The semen helps nourish sperm and carry them along.