Infertility in Men
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
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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
Some things that may raise the risk of this problem are:
- Having blockages in the genital tract, such as cysts and abnormal structures
- Prior surgeries
- Past infections, such as sexually transmitted infections (STIs) and prostatitis
- Genetic problems, such as cystic fibrosis
- Pituitary tumors
- 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
The main symptom is not being able to conceive after one year of unprotected sex.
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:
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:
Changes that may help are:
Medicine may be given to treat hormone imbalances. This may increase sperm count and quality.
Surgery may be done to repair a varicocele, correct an obstruction, or reverse a vasectomy.
Assisted Reproductive Technologies (ART)
ART uses 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. Methods are:
- Artificial insemination—Semen is collected and processed in a lab. It is then inserted into a person's cervix or uterus.
- In vitro fertilization (IVF)—An egg is removed and mixed with sperm in a lab. The egg and sperm mixture or a 2 to 3 day old embryo is then placed in the uterus.
- Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—An egg is removed and mixed with sperm in a lab. The egg and sperm mixture or a 2 to 3 day old embryo is then placed in the fallopian tube.
- Blastocyst intrafallopian transfer—An egg is removed, injected with sperm, and given time to develop. It is later placed in the uterus.
- Intracytoplasmic sperm injection—A single sperm is injected into the egg. The embryo can be placed into the uterus or frozen for later use.
Here are some things to avoid to lower the risk of this problem:
- Excess alcohol
- Illegal drug use
- Exposure to harmful chemicals and heavy metals
- Heat exposure from things like saunas and hot tubs
Reproductive Facts—American Society for Reproductive Medicine
Resolve—The National Infertility Association
Men's Health Centre
Sex & U—the Society of Obstetricians and Gynaecologists of Canada
Infertility in men. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/infertility-in-men-23. Accessed November 11, 2021.
Male infertility/andrology. American Society for Reproductive Medicine website. Available at: https://www.reproductivefacts.org/topics/topics-index/male-infertility. Accessed November 11, 2021.
Overview of infertility. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/infertility/overview-of-infertility. Accessed November 11, 2021.
Reproductive health and the workplace. National Institute for Occupational Safety and Health (NIOSH) website. Available at: https://www.cdc.gov/niosh/topics/repro. Accessed November 11, 2021
Last reviewed November 2021 by EBSCO Medical Review Board Mary-Beth Seymour, RN Last Updated: 11/12/2021