Male Infertility: Common Causes, Testing and Treatment Options

Infertility is a common problem that affects many couples. About 15% do not become pregnant after one year of consistent, unprotected sex.

Women may assume the problem is theirs, but men contribute to infertility about half of the time.

“As a society, we tend to focus on female infertility,” says Loyola Medicine urologist Denise Asafu-Adjei, MD, MPH.

“Many people aren’t even aware that men can have fertility issues. Increasing awareness is important because we can often treat male infertility and help couples become pregnant.”

What are the common types of male infertility?

Male reproduction depends on your ability to make healthy sperm and deliver it to your partner. The steps that lead to fertilization include:

1. Sperm production in the testicles
2. Sperm development as they move through a tube called the epididymis, where they gain their ability to swim
3. Mixing sperm with fluid from the prostate gland to form semen
4. Ejaculation into the female partner’s vagina
5. Movement of sperm through the uterus and to the fallopian tube
6. Fertilization if sperm meets egg

Male infertility is often a result of a problem in the testicles or the hormones that control male reproduction. A wide range of factors can cause these problems.

Dr. Asafu-Adjei separates the causes of male infertility into four broad categories:

• Anatomy: Anatomical causes of male infertility involve problems with the structure of the reproductive system. A common cause of male infertility is varicocele. Varicocele is an enlarged vein in the testicle that can lead to lower sperm production. A vasectomy is another anatomical cause of infertility. The procedure involves cutting and sealing the tubes that carry sperm. Many men seek a vasectomy as a form of male birth control before deciding they want children. 
   
• Hormones: A range of hormones produced in the hypothalamus, pituitary gland and testicles control sperm production and sex drive. A hormone imbalance can cause low sperm counts or sexual dysfunction. 
   
• Genetics: Genetic conditions due to abnormalities in your DNA can cause infertility. For example, most men with cystic fibrosis have a missing part of the tube that carries sperm. 
   
• Chemical exposures: Medications, infections, chemotherapy and environmental toxins can affect the testicles and their ability to produce sperm.

In some cases, doctors are unsure what causes infertility (idiopathic infertility).

How can you test for male fertility?

A semen analysis is the most important test in diagnosing infertility. This lab test evaluates your semen and measures the number of sperm, their shape and how well they move.

A thorough medical history and physical exam are also essential. These evaluations may hint at something in your background or current health that could cause infertility. Your doctor may also recommend tests to measure your hormone levels or look for genetic abnormalities.

“Making a diagnosis and identifying the underlying cause of male infertility is complex. It involves a careful assessment of your history, physical, semen analysis and other test results,” says Dr. Asafu-Adjei.

“Together, this information provides a full picture of what's going on and determines how to best treat you.”

What male infertility treatment options are available?

Each cause of male infertility has a unique set of treatments. “What’s most important is to work with your doctor to establish a treatment plan that meets your needs,” says Dr. Asafu-Adjei.

“Treatment should be based on you and your partner’s goals and timeline for having children. We also consider other factors such as age and underlying health conditions.”

Your treatment plan may include:

• No treatment: Some couples who don’t become pregnant during the first year of trying can still achieve pregnancy without intervention. Untreated, 23% will conceive within two years and 33% after four years. 
   
• Medical management: Medications can help correct hormone imbalances and treat other causes of infertility. If you currently take medications for conditions that could cause infertility, your doctor may recommend adjusting them. 
   
• Surgery: Surgery may be an option for correcting anatomical causes of infertility. For example, surgical procedures can repair varicocele, remove blockages or reverse a vasectomy. 
   
• Other fertility treatments: There are other procedures that can help couples who are having difficulties becoming pregnant. Make sure you ask your doctor about other available treatment options.

Can you boost male fertility?

A healthy lifestyle can help improve your overall health and fertility. For example, getting enough sleep is important since a lack of sleep can disrupt your hormone levels.

Other lifestyle changes that may improve male fertility include:

• Eating healthy foods
• Eliminating the use of marijuana and other drugs
• Exercising regularly
• Limiting alcohol
• Quitting smoking
• Reducing stress

Underwear selection (boxers vs. briefs) is less important, says Dr. Asafu-Adjei. “There is evidence that sperm production decreases when your scrotum is too warm,” she says.

“But you can wear boxers or briefs. Just make sure to ‘air out’ your testicles periodically throughout the day and allow them to cool down.”

Male infertility care at Loyola Medicine

Loyola’s urologists provide comprehensive care for men’s urological and reproductive health conditions. Specialists in our Men’s Health Center apply a holistic approach to address a wide range of men’s health conditions, including those that affect fertility. We work with doctors across Loyola, so you receive coordinated care.

Loyola Medicine's Men’s Health Center offers flexible hours and is located at Loyola Medicine Burr Ridge. To make an appointment, call 888-584-7888 or schedule an appointment online.

Denise Asafu-Adjei, MD, MPH, is a urologist at Loyola Medicine specializing in male infertility and sexual dysfunction. She earned her medical degree from the University of Michigan Medical School and completed her residency at New York Presbyterian/Columbia University Medical Center.

Dr. Asafu-Adjei provides personalized care to help her patients meet their sexual health and fertility goals. As a strong patient advocate, she strives to help patients feel empowered about having a better quality of life. Her areas of research include improving access to care for male infertility and sexual dysfunction. 

Book an appointment today to see Dr. Asafu-Adjei or another Loyola Medicine urologist by self-scheduling an in-person or virtual appointment using myLoyola.

Sources

• https://www.nichd.nih.gov/health/topics/menshealth/conditioninfo/infertility
• https://www.urologyhealth.org/urology-a-z/m/male-infertility
• https://www.ncbi.nlm.nih.gov/books/NBK562258/