Infertility in Men

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(Male Infertility)

Definition

Infertility is not being able to conceive after a year of regular, unprotected sex. About one-third of infertility is caused by male factors and one-third are caused by female factors. In the remaining cases, the cause is unknown or is due to problems with both partners.
Men are considered infertile if they:
  • Produce too few sperm cells
  • Produce sperm cells of poor quality
  • Have chronic problems with ejaculation

Causes

The Male Reproductive System
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Portions of the brain called the pituitary gland and hypothalamus, as well as male reproductive organs such as testes affect fertility in men. Problems in any of these areas may decrease fertility.
In about half of the cases, a cause cannot be found. Some factors that can contribute to infertility include:
  • Genetics diseases (such as, Klinefelter syndrome, Sertoli-Leydig cell syndrome)
  • Exposure to some workplace chemicals or heavy metals (primarily lead and cadmium)
  • Tobacco use, marijuana use
  • Varicose veins of the testes (varicocele)
  • Abnormal hormone levels
  • Infections
  • Physical abnormalities
  • Cancer
  • Medications
  • Obesity
  • Chronic diseases (such as, sickle cell anemia)
  • Excessive physical activity
  • Anti-sperm antibodies

Risk Factors

These factors increase your chance of developing infertility:
Tell your doctor if you have any of the above risk factors.

Symptoms

Inability to have a child after one year of trying to conceive.

Diagnosis

During the first visit, you and your partner will both be evaluated. The doctor will ask about symptoms, medical history, and work history. Your doctor will look for potential exposure to certain chemicals. Your doctor will also look for physical problems that might cause infertility.
The following tests will be done:
  • Blood tests—to find out the levels of different hormones that play a role in sperm development, including:
    • Testosterone
    • Luteinizing hormone
    • Follicle stimulating hormone
    • Prolactin levels
  • Semen analysis—examined for:
    • Amount of semen
    • Consistency of semen
    • Number of sperm
    • Movement of sperm
    • Shape of sperm
    • "Clumping" of sperm
    • Presence of substances other than sperm in the semen
  • Other tests:
    • Ultrasound—a test that uses sound waves to examine structures inside the body; transrectal ultrasound may be done to look for any enlarged vein around the testicles
    • X-rays—a test that uses radiation to take a picture of structures inside the body
    • Fertilization tests—to determine how well the sperm can penetrate an egg
    • Biopsy—removal of a sample of testicular tissue for testing
    • Post-coital test—to check if your sperm is compatible with the mucus in your partner's cervix

Treatment

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Lifestyle Changes

Lifestyle changes may include:
Ask you doctor if a daily antioxidant supplement may help.

Medication

If you have a hormonal imbalance, your doctor may prescribe medication. Clomiphene citrate (Clomid, Serophene), for example, is an anti-estrogen drug. In combination with vitamin E, it may help increase sperm count and improve sperm movement.

Surgery

Surgery is done for conditions like varicocele that can affect fertility. Treatment of a varicocele does not always restore fertility.
Surgery may also be done to reverse a vasectomy. This reversal is not always successful.

Assisted Reproductive Technologies (ART)

ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from you and your partner or donated. ART methods include:
  • Artificial insemination—semen is collected and processed in a lab. It is then inserted directly into the woman's cervix or uterus.
  • In vitro fertilization (IVF)—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
  • Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.
  • Blastocyst intrafallopian transfer—an egg is removed from the woman's body. Egg is injected with sperm and allowed to develop. It is later implanted into the uterus.
  • Intracytoplasmic sperm injection—a single sperm is injected into the egg. The resulting embryo can be implanted into the uterus or frozen for later use.

Prevention

Infertility cannot always be prevented; however, the following steps may help:
  • Avoid:
    • Use of tobacco, marijuana, opiates, and anabolic steroids
    • Exposure to harmful chemicals and heavy metals
    • Excessive use of alcohol
  • Protect yourself from STDs by using condoms. Minimize the number of sexual partners you have.

RESOURCES

American Society for Reproductive Medicine http://www.asrm.org

The Hormone Foundation http://www.hormone.org

RESOLVE: The National Infertility Association http://www.resolve.org

CANADIAN RESOURCES

Men's Health Centre http://www.menshealthcentre.net

SexualityandU.ca http://www.sexualityandu.ca

References

Infertility. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated August 23, 2012. Accessed September 14, 2012.

Jorgensen N, Carlsen E, Nermoen I, et al. East-West gradient in semen quality in the Nordic-Baltic area: a study of men from the general population in Denmark, Norway, Estonia and Finland. Hum Reprod. 2002;17:2199.

Male risks. Protect your fertility website. Available at: http://www.protectyourfertility.org/malerisks.html . Accessed September 14, 2012.

Reproductive health. The National Institute for Occupational Safety and Health website. Available at: http://www.cdc.gov/niosh/topics/repro . Accessed September 14, 2012.

Swan SH, Brazil C, Drobnis EZ, et al. Geographic differences in semen quality of fertile US males. Environ Health Perspect. 2003;111:414.

Vasectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated May 2011. Accessed September 14, 2012.

9/2/2009 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Ghanem H, Shaeer O, El-Segini A. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Fertil Steril. 2009 Mar 5. [Epub ahead of print]

2/14/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Showell M, Brown J, Yazdani A, Stankiewicz M, Hart R. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2011;(1):CD007411.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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