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What Is Male Infertility?

All About Male Infertility Diagnosis, Causes, and Treatment

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Updated October 21, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Infertility affects men and women equally.

Infertility affects men and women equally.

Photo: Noel Hendrickson / Getty Images

Male infertility isn't something you hear much about on the news, so you may be surprised to know that male infertility is almost as likely as female infertility to be involved in a couple's inability to achieve pregnancy.

The good news is that most cases of male infertility can be resolved either by treating the problem or using fertility treatments. When this is not the case, a couple facing male infertility may turn to a sperm donor or adoption to help build their family.

How Common Is Male Infertility?

About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. Out of this group, the following statistics on the cause of infertility generally apply:

  • One-third of couples will discover fertility problems in only the man.
  • One-third of couples will discover fertility problems in both partners or will have their infertility remain unexplained.
  • One-third of couples will discover fertility problems in only the woman.

How Is Male Infertility Diagnosed?

Male infertility is usually diagnosed by a semen analysis. This relatively simple test involves the man providing a semen sample for a lab to evaluate. The lab uses this sample to measure the amount of semen and the number of sperm, and to evaluate sperm shape and movement.

Ideally, the test should be performed at least twice to confirm results.

Read more about semen analysis:

Most of the time, basic semen analysis is all that's needed to diagnosis male infertility. However, further testing may include:

  • A general physical exam by a urologist
  • Specialized semen analysis, including genetic testing of the sperm (looking for the presence of antibodies) and evaluation of immobile sperm (to see if they are dead or alive)
  • Blood work to check hormone levels, usually of FSH and testosterone, but sometimes also LH, estradiol, or prolactin
  • Genetic karyotyping, if recurrent miscarriage is a problem
  • Ultrasound
  • Post-ejaculatory urinalysis (urine testing), to check for retrograde ejaculation
  • Testicular biopsy
  • Vasography

What Are the Symptoms of Male Infertility?

If a couple doesn't get pregnant after a year of unprotected intercourse, both the man and woman should be evaluated.

Unlike female infertility (where irregular periods may hint at a problem), obvious symptoms are not common with male infertility.

In some cases, hormonal problems may be suspected if a man has abnormal hair growth, low libido, or other indications of sexual dysfunction.

Risk factors for male infertility include obesity, age (over 40 -- yes, men also have biological clocks), current or previous infection of an STD, smoking, or excessive drinking. Some medications may also impair fertility.

What Causes Male Infertility?

Potential causes of male infertility are:

  • Complete absence of sperm (azoospermia)
  • Low sperm count (oligospermia)
  • Abnormal sperm shape (teratozoospermia)
  • Problems with sperm movement (asthenozoospermia)
  • Sperm that is completely immobile (necrozoospermia); the sperm may be alive and not moving, or they may be dead
  • Problems with sperm delivery, due to sexual dysfunction, an obstruction, previous vasectomy, or retrograde ejaculation
  • Problems with erections or other sexual problems

There are a variety of conditions that may lead to male infertility. The most common cause of male infertility is varicoceles. A varicocele is a varicose vein found in the scrotum. The extra heat caused by the vein can lead to low sperm count and impaired sperm movement.

What Are the Options for Male Infertility Treatment?

Some causes of male infertility are treatable or correctable through surgery. Options for treatment may include:

  • Treatment with antibiotics, in cases of infection
  • Surgical correction, in order to remove a varicocele, reverse a vasectomy, or repair a duct obstruction
  • Medications or fertility drugs to improve sperm production

In cases where the above treatments are unsuccessful, or when the cause for male infertility is unknown or untreatable, IUI treatment or IVF treatment may be suggested.

IUI treatment, where the sperm are transferred into the uterus via the cervix, is commonly used in cases of low sperm count or quality. IVF treatment may be suggested if IUI is not successful or appropriate, or if female infertility is a contributing problem.

In some cases, your doctor may recommend a procedure known as intracytoplasmic sperm injection (ICSI). Done as part of an IVF treatment, ICSI involves injecting a single sperm into an egg.

If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab. This would be done as part of an IVF treatment.

However, if none of these options are available, or if they are unsuccessful, your doctor may talk to you about using a sperm donor, or considering adoption, to help build your family.

More on the male side of infertility:

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Sources:

A Basic Guide to Male Infertility: How to Find Out What's Wrong. American Urologic Association. https://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/basic-page/a_basic_guide_to_male_infertility.pdf Accessed October 21, 2013.

Infertility: An Overview. American Society of Reproductive Medicine. Accessed April 23, 2009. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf

Infertility: Causes. MayoClinic. Accessed October 21, 2013. http://www.mayoclinic.com/health/infertility/ds00310/dsection=causes

Patient's Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society of Reproductive Medicine. Accessed April 23, 2009. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/Testing_Male-Fact.pdf

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