What Are The Symptoms Of Male Infertility?
Generally speaking, fertility specialists will often diagnose “male infertility” as the cause of a couple’s inability to conceive a child after a year or more of unprotected sex under circumstances marked by abnormal sperm function, low sperm production or inability to ejaculate preventing delivery of sperm. Infertility plagues approximately one couple out of every ten trying to become pregnant and male infertility in particular plays a contributing role in roughly 30 to 40 percent of cases. In about one-fifth of diagnoses, it is the sole reason a couple cannot naturally make a baby.
What Are The Most Common Causes Of Male Infertility?
Known as a varicocele, an unnatural dilation and tortuosity of veins within the spermatic cord can jeopardize healthy sperm, theoretically by abnormally increasing the internal testicular temperature. Around two-thirds of men who undergo a ligation procedure to tie off the affected veins will see the quality and volume of sperm produced improve significantly. However, patients with counts under 5 million sperm per cubic centimeter of semen or motility under 30 percent are far less likely to turn around their fertility to any significant degree and should consult a specialist about other avenues such as in vitro fertilization (IVF.)
Reproductive issues often prevent men who either have or have had an undescended testicle from fathering children, although diagnosing this issue as early as possible and undergoing surgical placement of the testicle in the scrotum no later than two years of age can dramatically improve the outlook for future fertility. This treatment’s effectiveness depends greatly on the undescended testicle’s location and the boy’s age.
Several infections, including but not limited to gonorrhea, can cripple male fertility by blocking the passage of sperm with buildup of scar tissue or directly interfering with the production or overall health of sperm. Some may irreversibly damage the testicles, but few entirely eliminate the possibility of retrieving sperm through alternate means.
Chemotherapy battles cancer by destroying abnormally reproducing and rapidly dividing cells indiscriminately. Unfortunately, drugs do not discriminate between malignant growth and such naturally prolific multipliers as the cells constituting hair follicles and the lining of the gastrointestinal tract or germ cells such as sperm and oocytes. Though constantly developed and produced sperm are often unintended casualties of killing off equally fast-regenerating cancerous masses, there is no way to reliably predict whether the resulting sterility will prove to be permanent.
Around 2 percent of the world’s male population cannot conceive children due to azoospermia, a fertility issue in which ejaculate contains virtually no sperm at all. This condition can be caused by several possible factors, ranging from genital injury, surgery to the male reproductive system or effects from radiation and chemotherapy treatments for cancer, blockage within the genitalia, infection or causes such as certain medications and illegal drugs, excessive consumption of alcohol, undescended testes or varicocele.
Low Sperm Count
A man who produces less than 15 million sperm per milliliter of semen is medically considered to have a “low” sperm count. Clinically known as oligospermia, this condition dramatically reduces the likelihood of conception but does not rule it out virtually completely as does azoospermia.
In addition to taking stock of a man’s overall sperm count and concentration, a semen analysis will also assess sperm morphology and health. Defects such as an abnormally shaped head or a double or crooked tail may limit an individual sperm’s likelihood of swimming to and penetrating an egg. Other considerations include the sperm’s general movement and the percentage confirmed to be alive within the ejaculate. An abnormal semen analysis does not necessarily indicate infertility but may predict a longer period of effort to become pregnant or the necessity of considering a sperm donor or undergoing in vitro fertilization.
Though it is far from unheard of for men to father children into their later years, the likelihood of conceiving and having a healthy child drops off considerably as fertility begins dropping off after the age of 40. Past that point, the decline in production of quality sperm lengthens the time it may take to become pregnant. Even if fertilization does occur, pregnancy will carry an increased risk of miscarriage due to the sperm’s questionable potential health.
A variety of legal prescription drugs including steroids, prescription opiates, antidepressants and even male fertility supplements not approved by the FDA can negatively impact a man’s fertility as severely as many illegal drugs. If you wish to father children and/or have experienced difficulty conceiving with your partner, consult your doctor immediately to arrange semen tests and discuss the potential side effects of any medications you have taken either currently or previously.
Growths developing on the pituitary gland and male reproductive system can directly and detrimentally interfere with their natural functions, diminishing a man’s capacity to father children. Meanwhile, primary cancer-control surgeries involving the complete removal of organs necessary to produce or deliver semen including the prostate gland, bladder and both testicles will also consequently cause infertility.
Genetic / Chromosome Abnormalities
Several chromosomal conditions including Klinefelter’s syndrome, a deleted Y chromosome can cause infertility by limiting sperm production or creating blockages to routes through the body. Sterility caused by a lone gene’s abnormality, such as congenital absence of the vas deferens due to a mutation of the one linked to cystic fibrosis, are less common but not unheard of.
In rare instances, male infertility can be traced back to hormonal deficiencies and imbalances. For instance, tumors and other conditions of the pituitary gland can ultimately limit production of Luteinizing and follicle-stimulating hormones essential for signaling the testes to produce both sperm and testosterone.
Retrograde Ejaculation And Similar Issues
Retrograde ejaculation is just one of multiple possible ejaculatory issues that can prevent a man from fathering children. Instead of ejecting from the penis, semen can occasionally back up into the bladder during climax, resulting in a “dry orgasm” that delivers little or no fluid. Although not harmful despite potentially resulting in infertility, retrograde ejaculation is typically treatable, as are a number of other conditions associated with blockages and other issues that limit or completely prevent normal delivery of semen.
Absence Of The The Vas Deferens
The vas deferens is the main pipeline that transports semen out of the body through the penis. In a condition known as Congenital Bilateral Absence of the Vas Deferens (CBAVD), this essential reproductive vessel fails to develop properly before birth. As a result, sperm has no exit path. This condition is frequently exhibited by men with mutations of the CFTR gene that causes cystic fibrosis.
Ductal blockages account for roughly 40 percent of diagnosed cases of azoospermia, a total absence of sperm from ejaculate that affects less than 2 percent of men overall but causes an estimated 15 percent of instances of male infertility. Though obstructions may stem from epididymal or ejaculatory duct pathology, vasectomy is statistically the most prolific cause. Obstructive infertility can also result from iatrogenic injury during scrotal or inguinal surgical procedures, severe genitourinary infections and congenital anomalies.
Spinal Cord Injury Treatments
Men living with spinal cord injuries often face multiple reproductive challenges. In addition to overall difficulty achieving and maintaining an erection, many patients experience difficulty ejaculating and produce fewer healthy sperm ideally suited to reaching and fertilizing an egg. Various penile stimulation techniques are often needed to harvest sperm for insemination via assisted reproductive procedures.
When sperm come into direct contact with a man’s immune system, the resulting reaction can cause his body to produce antibodies designed to damage or kill the reproductive cells. This can occur following testicular injury, infection of the prostate gland, reproductive system surgeries such as vasectomy or biopsy, and other conditions that prevent the testicles from sequestering sperm from the rest of the body as they normally would. A high enough volume of antibodies making contact with sperm will cause immunologic infertility.
Difficulty achieving or sustaining erection causes male infertility at the most fundamental level by preventing or interrupting basic intercourse. Though very treatable in the vast majority of instances, erectile dysfunction can result from an array of singular issues or a combination of factors.
Though the medical community continues to explore associations between celiac disease and male infertility to determine the nature of a causal relationship, studies have seen adoption of a gluten-free diet following a celiac disease diagnosis restore normal hormone levels and improve sperm characteristics in a significant number of cases.
Though still being explored by the endocrinology community, research has hinted that many common cleaning, cosmetic and food products may contain chemicals that threaten male fertility by disrupting testosterone and can lead to Testicular Dysgenesis Syndrome (TDS), a condition marked by various combinations of birth defects, testicular cancer and diminished sperm count.
For optimal health, sperm require an environment kept roughly four degrees cooler than the temperature of the rest of the body. This is why testicles have the cremaster muscle, a structure that contracts the testicles closer to the body in severely cold temperatures and allows them to hang lower in warmer environments. Prolonged exposure to elevated temperatures can handicap both healthy motility and sperm production while also killing off existing sperm.
Male fertility can often be jeopardized by exposure to radiation in two general ways. Doses as low as 600 cGy can cause irreversible damage to sperm-forming cells, though lesser doses may only temporarily reduce the quality and volume of sperm developed inside the testes. This is known as “primary testicular damage.” Secondary testicular failure occurs when radiation damages the pituitary gland in the brain and sabotages natural secretion of hormones needed for sexual function.
Wearing adequate waist protection during an x-ray diagnosis is especially essential for men who have already been made aware of impaired fertility, as well as men with sperm production already reduced by a history of alcoholism or weight issues. Otherwise, healthy and fertile men have nothing to fear as long as proper shielding is in place.
Household or occupational exposure to lead and other heavy metals has been associated with an estimated one-fifth of male infertility diagnoses. Studies have found that sperm delivered by semen with elevated lead levels had difficulty properly binding themselves to eggs or stimulating the needed reaction to penetrate an oocyte.
Habitual use of illegal drugs such as cocaine and marijuana has been shown to at least temporarily reduce sperm production.
Although the exact mechanisms by which alcohol may damage fertility have not yet been definitively explained, frequent over-consumption can dramatically reduce libido, cause impotence and depress overall sperm quality.
In addition to increasing the risk of infertility or miscarriage by damaging DNA in sperm, studies have shown that cigarette smoke can severely restrict blood flow in erectile tissue needed to create and maintain an erection.
Anabolic steroids deceive the body into thinking it no longer needs to produce testosterone. Lack of testosterone in the testicles then stops the body from releasing the follicle-stimulating hormone that triggers the development of sperm.
Despite not having a single conclusive explanation, researchers have theorized that infertility caused by prolonged stress may affect semen quality both by signaling the release of steroid hormones called glucocorticoids that reduce sperm and testosterone production by affecting metabolism of fats, protein and carbohydrates or triggering oxidative physiological duress caused by unneutralized free radicals.
Obese men tend to exhibit lower testosterone levels and increased risk of erectile dysfunction, two significant factors in male infertility.
Multiple infections of gonorrhea or Chlamydia trachomatis, among other sexually transmitted diseases, can result in infertility caused by blocked sperm passages and internal scarring. Human papillomaviruses (HPV), the organism known to cause genital warts, is also believed to handicap sperm function.
How Is Male Infertility Diagnosed?
Diagnosing male fertility is often fairly straightforward. Blood tests can determine whether a hormonal imbalance may be affecting normal sperm production. Meanwhile, a semen analysis can evaluate the count, motility and shape of sperm contained in a typical volume of ejaculate.
What Male Infertility Tests Can Be Performed?
A special substance added to a semen sample will bind only to sperm attacked by unusual proteins created when the body’s immune system comes into direct contact with male reproductive fluid.
Sperm And Semen Analysis
Doctors will frequently order multiple semen analyses spaced at least seven days apart over the course of two to three months in order to assess the number, shape and motility of sperm while accounting for factors that can vary on a daily basis.
A routine physical examination may highlight contributing factors to infertility such as cardiovascular health, obesity, infections and effects of environmental and lifestyle influences. Your doctor will measure your height, weight, blood pressure and body mass, in addition to assessing gynecomastia and secondary sex characteristics of the testes, penis and epididymides.
By testing pituitary-gonadal hormones, your doctor can learn a great deal about the state of your sperm production and monitor any abnormalities that may hinder your efforts to conceive.
Your doctor may be able to accurately predict your likelihood of fathering a child by removing a small sample from one or both testicles and examining it beneath a microscope in search of any critical abnormalities.
A Y chromosome microdeletion or cystic fibrosis gene test can reveal missing or misspelled genetic information that could cause abnormal sperm production.
Following confirmation of a low sperm count, your fertility specialist may recommend testing your blood to measure FSH, LH, prolactin and testosterone levels and possibly recommend one of several supplements proven to improve sperm production, motility and morphology.
Sperm Penetration Assay
This test most often performed at fertility urologist clinics, determines whether a man’s sperm can join with a human egg by counting the number of sperm that penetrate a hamster ovum in a laboratory setting.
Hypo-osmotic Solution Assay
A sperm requires optimal membrane functionality and integrity in order to reach its ideal binding potential during fertilization. A hypo-osmotic solution assay can measure this key characteristic by determining sperm’s ability to maintain equilibrium with its environment. Specifically, higher percentages of sperm that balloon within the solution indicate development of functional, intact plasma membranes.
Retrograde Semen Analysis
In cases of retrograde ejaculation, patients can often still father children using their sperm. Since semen flows back into the bladder during ejaculation, a retrograde sperm analysis can determine if enough can be harvested from a urine sample for artificial insemination to have a reasonable likelihood of success.
What Do Doctors Look For By Testing?
Volume Of Semen
Lower measurements may occur following very frequent ejaculation and higher levels typically follow prolonged abstinence, but a human male produces an average volume of two to five milliliters of semen at ejaculation. Volumes lower than 1.5ml (hypospermia) or greater than 5.5ml (hyperspermia) indicate abnormal fertility.
“Normal” sperm density in a semen sample can measure anywhere between 20 million and 200 million sperm per cubic centimeter.
Healthy sperm develop a long tail behind an oval head. Abnormal sperm can have difficulty reaching an egg due to defects such as large or misshapen heads and double or crooked tails.
Quality sperm should swim along a consistent forward path that tends to strike the shortest route to the egg. Sperm that swim in circles or veer off-course are considered “abnormal” and ill adapted for fertilization. This measurement of sperm health can vary drastically with changes in environmental temperature.
Sperm delivered in hyperviscous semen often fail to successfully travel from the site of deposit to the cervix or uterus. Fertility specialists ordinarily deem a liquefied specimen’s viscosity “normal” if it can pour drop-by-drop from a graduated beaker.
What Male Infertility Treatment Options Are There?
Medications To Increase Sperm Count – Surprisingly to many men, a number fertility drugs commonly prescribed to women including clomiphene citrate, human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) are often also employed to treat male patients with secondary hypogonadism, a form of reduced or absent hormone secretion leading to decreased physiological activity of the ovaries or testes.
Antibiotics To Heal Infections
If administered early, prescription antibiotics can defeat infections of reproductive organs before their resulting damages can reduce fertility.
Varicoceles Are Repaired
Researchers have noted that rectifying genital blood flow with surgical or nonsurgical repairing of varicoceles frequently restores normal pregnancy rates to pre-affliction status.
Hormonal Abnormalities Treatment
Fertility specialists frequently recommend bromocriptine (Parlodel) to correct reductions in sex drive and sperm production caused by excessive levels of prolactin. Clomiphene citrate can also get sperm production back on track by improving LH and FSH output. Finally, injectable gonadotropins such as hMG and hCG are often called upon to treat conditions that disrupt signals for the testes to develop sperm.
There are generally two ways to overcome obstructive azoospermia: surgical correction frequently allows couples to eventually conceive naturally, but sperm can also be retrieved directly from the testes or epididymis and later used in IVF.
Electroejaculation Therapy (EEJ)
Performed either with or without general anaesthesia as befits individual patient circumstances, EEJ has long been used safely and effectively to obtain suitably motile sperm from spinal cord injury patients for use in assisted reproductive techniques including IVF and intrauterine insemination (IUI).
A standard step in many infertility treatments, this process involves separating individual sperms from semen for later use in IVF or IUI procedures. Benefits of sperm washing include improving chances of fertilization by removing mucus and non-motile sperm, as well as decreasing HIV transmission risk by extracting disease-carrying material.
Surgical Sperm Retrieval
Primarily recommended for men seeking to father children after a vasectomy or suffering from obstructive infertility to infection or injury, congenital absence of the vas deferens or non-obstructive azoospermia, this alternative reproductive avenue involves collecting, freezing and storing sperm either from at least a single biopsy of testicular tissue or using an extremely fine needle inserted directly into the epididymis. Both techniques are performed under a local and light general anaesthetic during a hospital stay lasting only a few hours.
Percutaneous Epididymal Sperm Aspiration (PESA)
This less costly and technically simpler treatment alternative to micro-epidydimal sperm aspiration (MESA) determines a patient’s sperm count when a vas deferens blockage is the suspected culprit of male infertility. Your doctor will insert a tiny need through the scrotal skin collect sperm by penetrating the epididymis. Doctors frequently also employ this technique to harvest sperm for use in intracytoplasmic sperm injection (ICSI.)
Testicular Sperm Extraction (TESE)
In ICSI, the TESE process acquires a small portion of viable sperm cells present in a sample of testicular tissue surgically harvested under local anaesthesia.
This procedure differs slightly from traditional TESE in that an operating microscope is used to more thoroughly examine and remove testicular tissue that appears most likely to be engaged in producing sperm.
Intrauterine Insemination (IUI)
This treatment allows increased numbers of sperm to reach the fallopian tubes by placing a sample directly inside the uterus, improving the chances of fertilization.
Human Chorionic Gonadotropin (hCG)
Widely prescribed as a fertility enhancement for female patients, treatment cycles of two to three weekly injections over the course of up to six months have been clinically proven to also improve testosterone production and sperm counts in male patients.
Human Menopausal Gonadotropin (hMG)
If an hCG regimen fails to pivotally improve male fertility within six months, your doctor may recommend adding hMG to the next cycle of treatments. The difference between the two? Whereas hCG’s makeup strongly resembles the luteinizing hormone (LH) responsible for triggering Leydig cell testosterone production, hMG contains actual LH.
Recombinant Human Follicle Stimulating Hormone (rhFSH) – Like hCG and hMG, therapy introducing rhFSH can stimulate the testes to ramp up sperm production in the event the two aforementioned gonadotropins prove ineffective.
Gonadotropin Releasing Hormone (GnRH)
The pharmaceutical form of GnRH is designed to boost the release from the anterior pituitary gland of hormones vital to sperm production, making it a vital asset to assisted reproduction and the treatment of male infertility.
Clomiphene Citrate (Clomid, Serophene)
Prescribed clomiphene citrate formulations such as Clomid and Serophene are commonly prescribed non-steroidal medications recommended to address both low sperm count and female infertility by ramping up testosterone production and sperm synthesis in men and ovulation and egg production in women.
In-vitro Fertilization (IVF)
In the event natural conception remains either an impossibility or prohibitively difficult after clinical treatment options have been exhausted, IVF may still allow fertility-challenged couples to become pregnant by their own sperm and eggs. The process involves collecting mature eggs directly from the ovaries, fertilizing them in a lab with a partner’s sperm and finally implanting the embryo in the mother’s uterus.
Intracytoplasmic Sperm Injection (ICSI)
In both IVF and ICSI, an egg is fertilized by sperm in a controlled laboratory setting. However, the two procedures are not identical. IVF entails mixing the egg and semen in the same dish and allowing the sperm to independently fertilize the egg. ICSI involves manually injecting a single viable sperm directly into the egg.
Healthy Eating, Limited Drinking, No Smoking Or Drugs
Many instances of male infertility have been successfully addressed with basic lifestyle changes. Clinical research has repeatedly linked obesity, alcoholism, tobacco and habitual use of illegal drugs to loss of libido, impotence and dramatically decreased sperm production and quality. Addressing these lifestyle issues may lead not only to improved fertility but lasting improvements to overall health.
Studies have consistently shown that regular moderate to high-intensity exercise significantly improves blood flow throughout the body and increases testosterone production, both of which are critical to prime sexual health and long-term fertility.
Avoid Hot Tubs, Saunas
Prolonged exposure to extreme heat frequently leads to temporary dropoffs in the production and motility of sperm.
Wear Looser Underwear
Tight undergarments can restrict circulation to the lower body, cutting the testes off from the blood flow needed to sustain consistent sperm development.
Can Male Infertility Be Prevented?
Yes and no. In many instances, there are plenty of steps men can take to enhance their long-term outlook for fathering children that also happen to simply be conducive to an overall healthy lifestyle. Eating well, limiting alcohol and abstaining entirely from tobacco and illegal drugs are important steps toward building a family. These are the building blocks of an all-around better body and more sound mind. The same goes for avoiding lengthy exposure to chemicals, toxic substances and intense radiation.
In other cases, physicians and patients can address medical impediments to conception with various modern solutions from hormonal therapies to corrective surgeries and assisted reproductive techniques. However, male infertility is unavoidable and incurable in rare circumstances mired by congenital factors, illness or miscellaneous inexplicable causes.
The surest path forward will always be a candid dialogue with your partner and your doctor.