Infertility in Men

What is infertility?

Infertility is the failure of a couple to get pregnant after having regular sexual intercourse without birth control for at least 1 year (or 6 months if the woman is 35 or older). A couple may also be infertile if they can get pregnant but can’t stay pregnant until the baby is old enough to be delivered.

Infertility is a problem for 1 of every 6 couples. It can be caused by problems in a man's or a woman's reproductive system. Problems in the man's body are responsible for about half of the cases of infertility.

What is the cause?

Most often a man is infertile because he doesn’t make enough sperm. Some of the reasons for this may be:

• smoking
• alcohol or drug abuse
• exposure to chemicals or radiation
• being in hot-tubs too much
• hormone problems
• severe injury to the testicles
• wearing tight underwear, such as jockey shorts, all the time
• having sex too often (every day) so there is not enough time to develop mature sperm
• a genetic problem, such as Klinefelter’s Syndrome

Sometimes the sperm are not normal. For example, they may not be able to move properly or their lifespan may be too short. (A normal sperm has a lifespan of about 3 days.) For example, abnormal sperm can result from:

• testicles that are irritated and swollen (a possible complication of having mumps as an adult)
• a varicocele, which is a swelling of veins in the scrotum (the scrotum is the sac that holds the testicles)
• abnormally developed testicles

Sometimes the problem is getting the sperm into the woman's vagina. This may be a problem because of:

• infection of the genital organs, which can block the passage of sperm
• ejaculation that happens too early during lovemaking
• retrograde ejaculation (semen is forced back into the man's bladder), which may be caused by bladder, prostate, or urethral surgery; diabetes; or some medicines
• inability to keep an erection (possibly due to side effects of some medicines or diseases such as Peyronie's disease)

Other possible causes are:

• severe injury, major surgery, or medical illness, such as diabetes
• abnormalities of the penis
• medicines such as steroids
• using lubricants during sex (they can make it harder for the sperm to reach the egg)
• the natural loss of fertility that happens as men get older, especially after age 40

How is it diagnosed?

At first, you and your partner will probably see your healthcare provider. Your provider may refer you to a specialist.

You and your partner will have thorough physical exams. You will be asked about:

• your sexual history, including previous pregnancies
• your medical and family history
• medicines that you take
• your use of drugs, alcohol, and tobacco
• exposure to chemicals, for example, at your job
• your sexual practices, such as how often you have sex, whether you use lubricants, and if you have any problems during sex

Men may have the following tests:

• test of semen to check the number and quality of sperm
• blood tests
• test of fluid from the penis to check for infections
• ultrasound scan.

How is it treated?

If you have a disorder causing infertility, treatment may include medicine or surgery. Sometimes both partners need treatment.

Depending on what seems to be causing infertility, possible treatments for a man's infertility are:

• Taking hormones for a hormone imbalance.
• Taking medicine to help you make more sperm.
• Taking an antibiotic for an infection.
• Taking medicine that can help with ejaculation problems.
• Avoiding long, hot showers and frequent use of hot tubs and saunas. High temperatures can lower your sperm count. It also may help to wear boxer shorts rather than jockey shorts.
• Stopping use of lubricants during sex.
• Having sex less often.
• Quitting smoking if you are a smoker.
• Quitting use of alcohol or illegal drugs.
• Having therapy to treat ejaculation problems.
• Having surgery to correct a disorder in the testicles or to remove a blockage of the tubes that carry the sperm.

If your sperm count is low, artificial insemination may be a tried. When this is done, semen is collected at several different times and stored until there are enough sperm. The semen is then put in your partner's uterus or fallopian tubes during the most fertile time of her menstrual cycle. This procedure has varying success. If your sperm count is still too low or there is something else wrong with your sperm, you may want to consider using sperm donated by another man. (If you choose to use sperm donated by another man, only use sperm banks that properly screen for sexually transmitted diseases and other medical illnesses in the donor and his family.)

In vitro fertilization is another option: Eggs are removed from the woman and fertilized with sperm in the lab. The fertilized eggs are then put back into the woman's body. This procedure may be done if your sperm count is low or your partner's fallopian tubes are blocked or damaged.

Looking for and treating causes of infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through hard times.

How can I help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or some illnesses. However, you can do the following to lower your risk of having problems that might cause infertility:

• Prevent sexually transmitted diseases by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Do not have sex every day.
• Do not use lubricants during sex.
• Limit the amount of alcohol you drink to no more than 1 to 2 drinks a week.
• Avoid the use of street drugs (such as heroin).
• Don’t overuse prescription and nonprescription drugs.
• Don’t smoke.
• Avoid exposure to toxic substances such as industrial chemicals, weed killers, and pesticides.
• Avoid exposure to radiation.
• Avoid long, hot-tub baths.
• Don’t wear tight underwear.
• Practice good personal hygiene to prevent infections.
• Take any hormones, antibiotics, or other medicines as prescribed by your healthcare provider.