Infertility can be a deeply personal and often distressing challenge that affects millions of couples every year. However, infertility is not just a women’s issue. While female reproductive health typically garners more attention, male infertility is a significant and contributing factor. In fact, male infertility is the cause or contributing factor in nearly half of all infertility cases.
Yet, despite its prevalence, male infertility remains a topic surrounded by misconceptions and stigma, causing many men to suffer in silence.
Understanding the causes and symptoms of infertility is crucial for better managing your reproductive health and exploring potential fertility solutions.
[Read: How to Find a Good Fertility Clinic.]
What Is Male Infertility?
Male infertility is a condition of the male reproductive system that is characterized by the inability to achieve conception with a fertile female partner, typically after one year of unprotected sex.
About 10% to 20% of couples experience idiopathic infertility, meaning there’s no clear identifiable cause. Despite normal sperm parameters, the male remains infertile.
[READ: Primary Doctors for Men.]
Causes of Male Infertility
More often, there are identifiable causes of male infertility. Several contributing factors that can lead to either reversible or irreversible male infertility include:
— Environmental factors
— Lifestyle factors
— Genetics
— Medical conditions
Environmental factors
Male fertility rates have dramatically declined over the past 50 years, and many studies suggest the drop can in large part can be attributed to chronic environmental toxin exposures, including:
— Ionizing radiation. Radiation from imaging and diagnostic tests — such as from X-rays and CT scans — have enough energy to damage sperm cells, leading to mutations, cell death and disruptions in normal sperm development and function, reducing sperm count and quality.
— Electromagnetic radiation. Some early animal studies suggest that electromagnetic radiation from mobile phones and laptops are associated with decreased sperm motility and viability. Further studies are needed to clearly understand the impact of these devices on male fertility.
— Pollution. Exposure to toxins and chemicals, including pesticides, heavy metals or industrial chemicals used in various products can disrupt hormonal balance, damage sperm, cause oxidative stress and inflammation, and impair the overall function of the reproductive system.
— Heat exposure. Frequent use of hot tubs, saunas or tight clothing that increases scrotal temperature can impair sperm production and function.
“There’s a reason why the testicles sit away from the male’s body and in the scrotum, which is a few degrees cooler than the rest of the body — because that’s the ideal temperature for sperm production,” adds Dr. Jonathan Davila, a urologist and director of male fertility at Staten Island University Hospital, a division of Northwell Health, in New York City.
Lifestyle factors
Various lifestyle habits can impact sperm quality, hormonal balances and overall reproductive health, including:
— Lack of or excessive exercise
— Poor sleep
— Smoking, including marijuana and cigarettes
— Substance use, including excess alcohol consumption, opioid or narcotic intake
— Use of anabolic steroids or testosterone supplements
— Chronic stress
Genetics
Key genetic factors that may impact male infertility include:
— Chromosomal abnormalities
— Single gene mutations, such as with cystic fibrosis
— Hormonal disorders
— Genetic syndromes
Men may still produce an ejaculate volume, but sperm will not be present in the semen.
“There won’t be any fish in the river,” Davila describes.
Medical conditions
Some medical conditions can affect male fertility, such as:
— Anatomical abnormalities
— Physical issues, like with sperm formation
— Varicocele, one of the most common reversible causes of infertility in which the veins within the scrotum become enlarged, leading to poor blood flow and vein dilation
— Infections, including sexually transmitted diseases, prostatitis or testicular epididymitis
— Scar tissue that could block passage of the sperm
— Certain chronic medical conditions, including diabetes and obesity
— Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), used for psychiatric disorders
— Prior treatments or surgeries for conditions — such as testicular or prostate cancer — that may have impacted reproductive organs
[READ: How to Cope With Common Sex Problems.]
Symptoms of Male Infertility
Common signs or symptoms of male infertility, particularly if you aren’t actively trying to conceive, include:
— Difficulties ejaculating
— Testicular discomfort
— Testicular atrophy
— Chronic dull, aching pain
The dull, aching pain may get worse throughout the day if you’re experiencing varicocele.
[Related:Prostate Cancer in Younger Men, 8 Things to Know]
Diagnosis of Male Infertility
If you’re under 35 and have been actively trying to conceive for a year without success, it’s advisable to schedule an initial fertility consultation. If you’re 35 or older, your doctor may recommend a consultation after six months of trying.
Assessing male fertility typically involves a series of steps to determine the underlying factors contributing to infertility.
These steps include:
1. Medical history and physical examination
Your health care provider will review your medical history, including:
— Medical conditions or illnesses
— Medications
— Surgical history
— Family history
— Reproductive history
— Lifestyle habits (such as alcohol consumption, smoking and drug use)
During the physical examination, your provider will check for any anatomical abnormalities or signs of underlying medical issues, while focusing on the genitals to assess a variety of conditions, including:
— Testicular size
— Hydrocele, a swelling of the scrotum
— Varicocele, a swelling of the scrotal veins
2. Semen analysis
Semen is collected via masturbation into a sterile container, and the semen sample is analyzed to evaluate several parameters, including:
— Sperm count
— Sperm motility
— Sperm morphology
— Semen volume
Because semen quality can vary from one sample to the next, a semen analysis is done twice to ensure the accuracy and reliability of the results. A number of factors can impact a semen analysis — such as stress, illness or recent ejaculation — so repeat testing helps confirm the initial results.
3. Testing
Your health care provider will conduct a series of testing. This may include:
Genetic testing
Your doctor may test for any underlying genetic conditions that could be impacting fertility. Male fertility can be affected by chromosomal abnormalities, single-gene mutations and structural disorders, which may include:
— Klinefelter syndrome, which is when men have an extra X chromosome
— Y chromosome microdeletions, when part of the Y chromosome is missing
— Chromosomal translocation, meaning a rearrangement of a chromosome
— Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation
Hormonal testing
Bloodwork to test for abnormal hormone levels can indicate issues with testicular function and sperm production.
The hormonal test typically checks for levels of:
— Serum follicle-stimulating hormone (FSH)
— Luteinizing hormone (LH)
— Prolactin
— Estradiol
If hormonal levels are off, your doctor may refer you to an endocrinologist.
Screening for medical conditions
Screening for undiagnosed comorbidities is important for ruling out underlying medical conditions that may be affecting fertility.
For example, Davila often sees men with undiagnosed diabetes, which can affect male fertility by causing erectile dysfunction or poor semen quality.
“When we do a preliminary screening workup, they’ve realized they’ve had uncontrolled diabetes for years, and they’ve been suffering from the symptoms in silence just because they’ve never gone to see a physician,” Davila says.
4. Imaging studies
Your provider may do an ultrasound of the scrotum, which can help identify contributing factors such as varicoceles, testicular tumors or other structural abnormalities.
If a physical obstruction is identified, you may be referred to a urologist who could then surgically correct the obstruction.
5. Consultation and results interpretation
Based on the results of your assessments, you’ll meet with your health care provider to discuss findings, any potential causes of infertility and available lifestyle interventions or treatment options. If additional testing or follow-up with a medical specialist is required, your doctor will let you know.
Improving Male Fertility
Not all causes and contributing factors of male infertility can be addressed, such as genetics or many environmental factors.
However, many are modifiable, and with lifestyle changes, you can reverse potential damage.
“Sperm regenerates continuously, so within 90 days, sperm should be completely turned over,” says Dr. John Lynam, an osteopathic urologist physician at the Advanced Urology Institute in Oxford, Florida. “Sperm is constantly being reproduced and regenerated.”
Modifiable lifestyle changes that can help reverse damaged sperm and improve sperm quality include:
1. Lose weight
Obesity and being overweight is harmful to overall health, including male fertility. That’s because body fat contains aromatase, an enzyme that converts testosterone into estrogen.
“The more fat you have, the more estrogen you’ll make and the less testosterone you’ll have,” Davila explains.
As a result, losing weight and maintaining an overall healthy body weight can help improve hormonal balance and enhance sperm quality. Weight loss measures include:
— Eating a healthy diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats
— Getting regular physical activity, aiming weekly for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity
— Considering medical interventions in some cases, such as weight loss medications or bariatric surgery
— Reducing alcohol intake, which will not only help maintain a healthier weight, but will also cut down on harmful substances that could be impacting sperm quality
2. Be mindful of electronic devices
Environmental factors can be very hard to control, especially as we rely more and more on our electronic devices, which emit low levels of radiofrequency radiation.
“Passive radiation can affect our production and be really strongly associated with declining sperm counts, impaired sperm motility, abnormal sperm shape — which all makes the sperm relatively nonviable from a fertility and pregnancy standpoint,” Lynam says.
However, there are some small steps you can take in everyday life to modify harmful environmental influences from your electronic devices.
Lynam recommends being mindful of where you keep your cellphone and laptop. For example, keep your phone out of the front pocket, which is close to the testicles, and avoid having laptops sit on your lap all day.
3. Quit smoking
Not only is tobacco use associated with adverse health outcomes and numerous chronic diseases, even at low levels, but studies have shown tobacco’s harmful effects extend to male fertility too.
“A lot of studies show that smoking does hamper down on sperm motility and production,” Davila says. “Simply stopping (smoking) can help.”
Recent studies have also shown that nicotine and other carcinogenic chemicals in tobacco can affect genetic integrity and hormonal balances in addition to sperm quality.
Seek support from health care providers or smoking cessation programs for personalized advice and assistance in quitting. Behavioral counseling and medications can also be used to help achieve and maintain smoking cessation.
Fertility Treatment Options
Beyond lifestyle interventions, men have access to a range of fertility treatment options, depending on the underlying cause:
— Assisted reproductive technologies. Options, including intrauterine insemination (IUI) or in vitro fertilization (IVF), offer effective methods to help achieve conception.
— Hormone therapies. Hormone therapy can help address imbalances that are affecting sperm production.
— Surgical interventions. Surgical interventions — such as to remove a blockage or reverse a vasectomy — may be used to repair or reverse issues or improve fertility by addressing anatomical obstructions or previous surgical interventions.
Consulting with a fertility specialist will help you determine the most suitable treatment approach to maximize chances of successful conception.
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Male Infertility: Causes, Symptoms and Treatments originally appeared on usnews.com
