Definition

Infertility is not being able to conceive after a year of regular, unprotected sex. Men are considered infertile if they:

• Do not make enough sperm cells
• Make poor quality sperm cells
• Have problems with ejaculation

The Male Reproductive System

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Causes

In some people the cause is not known. In others, it may be due to:

• Enlarged veins in the scrotum— varicocele
• A blockage in the genital tract
• Abnormal hormone levels
• Infections, such as sexually transmitted infections (STIs), prostatitis, and tuberculosis
• Undescended testicle(s)
• Genetic problems such as Klinefelter syndrome
• Sperm DNA damage
• Problems with the immune system
• Exposure to workplace chemicals or heavy metals, such as lead and cadmium

Risk Factors

Some things that may raise the risk of this problem are:

• Having blockages in the genital tract, such as cysts and abnormal structures
• Trauma
• Prior surgeries
• Past infections, such as sexually transmitted infections (STIs) and prostatitis
• Genetic problems, such as cystic fibrosis
• Obesity
• Pituitary tumors
• Hypothyroidism
• Certain health problems that affect the whole body, such as diabetes, cirrhosis, and high blood pressure
• Alcohol use disorder
• Tobacco use disorder
• Marijuana or cocaine use
• Exposure to radiation, toxic chemicals, and heavy metals
• High scrotal temperature due to things like hot tubs, tight underwear, and bicycling
• Certain medicines, such as alpha and beta blockers, anabolic steroids, and diuretics

Symptoms

The main symptom is not being able to conceive after one year of unprotected sex.

Diagnosis

The doctor will ask about your symptoms and health history. You will be asked about the work that you do and whether you have been exposed to certain toxins. A physical exam will be done. Your partner may also be referred for testing.

Your fluids and tissues may be tested. This can be done with:

• Semen analysis
• Blood tests to look for problems with hormones or genes
• Urine tests
• Biopsy of the testes

Images may be taken. This can be done with:

• Ultrasound
• MRI scan

Treatment

The goal of treatment is to improve the changes of conception. It will depend on what is causing the problem. Some treatments can be expensive and may not be covered by insurance. Options are:

Prevention

Here are some things to avoid to lower the risk of this problem:

• Excess alcohol
• Tobacco
• Marijuana
• Illegal drug use
• Exposure to harmful chemicals and heavy metals
• Heat exposure from things like saunas and hot tubs