Infertility is a common condition in which a man (or a woman) is unable to produce offspring. The major cause of male infertility is failure to produce enough healthy sperm.
You won't normally have any obvious symptoms apart from the fact that your partner cannot become pregnant.
- About one in six couples have problems getting pregnant, and male fertility is the reason in about 50% of cases.
- Around one man in twelve has some sort of fertility problem.
Sperm problems are the leading cause, and account for perhaps 75% of male infertility cases. On average about 100—750 million sperm are ejaculated during orgasm, but only a few hundred make it to the fallopian tube where the egg is fertilised. Any reduction in the sperm count (i.e. in the number of sperm), or any problem with their quality, reduces the chances of conception.
To be of good quality, sufficient numbers of sperm must be "motile", i.e. moving positively rather than aimlessly swimming around in circles, and normally shaped rather than malformed. Enough sperm must also be capable of escaping from the seminal fluid in which they were ejaculated and of penetrating the woman's cervical mucus as well as the egg's outer covering.
Sperm problems can be caused by:
- Trapped sperm inside the testicles.
- Mumps can cause orchitis (an inflammation of one or both testicles), which may in turn result in reduced sperm production.
- Antibodies which make sperm clump together so that they can't move properly.
- Sexually transmitted infections can damage the tubes where sperm are made and stored.
- Testicles that don't descend into the scrotum at birth are damaged by staying in the body, where the higher temperature leads to reduced sperm production and poor quality sperm. Fertility can be affected even if the undescended testicles are surgically corrected before a child is two years old.
- Hormonal causes, though these are not particularly common.
- Enlarged veins round the testicles called varicoceles.
- Genetic causes. Several inherited conditions can cause problems, including Klinefelter syndrome. About 11% of men with no sperm in their semen have this condition, as have around 2% of those with low sperm counts.
- Cancer drugs can cause temporary and, sometimes, permanent damage to sperm-producing cells.
- Poor quality sperm after vasectomy reversal.
Other reasons for fertility problems include:
- Ejaculation problems, e.g. retrograde ejaculation which feels like a dry ejaculation. Semen ends up in the bladder because the bladder neck doesn't close tightly enough.
- Spinal cord injury and diseases such as diabetes may affect the nervous system so that semen can't be pumped into the urethra.
- Hypospadias is one of the most common genital birth defects in male babies. The urethra opens on the underside of the penis so that semen isn't ejaculated into the vagina (although the sperm itself may well still be healthy).
- Erectile dysfunction (impotence) — getting your partner pregnant is going to be a problem if, for whatever reason, you regularly have problems getting an erection.
- Use condoms to avoid sexually transmitted diseases.
- If you are taking any medicines check whether they could affect sperm quality — quite a few can, e.g. some blood pressure drugs and antidepressants. If this is the case ask about alternative drugs that won't have this side-effect.
- Don't use anabolic steroids as they shut off sperm production.
- Cannabis — watch out! Just one joint can affect sperm manufacture for 36 hours.
- Vaginal lubricants are not a good idea as many kill sperm. KY-Jelly as well as specifically spermicidal lubricants are toxic to sperm, and even saliva can impair sperm motility.
- Store sperm before any cancer treatment.
- Lifestyle changes such as quitting smoking and drinking in moderation could help.
- Ask for a lead shield if you require an abdominal X-ray.
- Don't panic if your partner doesn't become pregnant straightaway — conception takes time even for the most fertile of couples. The usual rule of thumb is to wait a year before seeking help.
- However, visit your GP immediately if you think you may have problems, e.g. you have had undescended testicles, mumps, orchitis, surgery in the pelvic area (hernia repair), regular contact with substances such as lead, ejaculation or erection problems, or are producing hardly any semen or if there is blood in it.
- Your partner also needs to be checked out because (obviously) it takes two to make a baby and good clinics assess a couple's fertility rather than looking at one partner in isolation.
- Semen analysis.
- Medical history to find out whether anything has happened which could have affected your fertility. Your GP will also ask whether you've got anyone pregnant before.
- A physical examination to check for things like genital abnormalities and varicoceles.
- Sperm function tests.
- Blood tests to check for acute infections that could be damaging sperm.
- Urine tests for chlamydia
- Hormonal blood tests — the key one measures FSH (follicle stimulating hormone), as very high levels indicate that sperm production has failed.
- Genetic tests include a blood test called a karyotype, which looks for major chromosomal abnormalities. Some research laboratories offer a more specialised blood test to look for problems on the Y chromosome, and some research centres assess the extent of chromosomal abnormalities in sperm.
- Testicular biopsy — a tiny sample of tissue may be extracted using a needle to find out what's happening to sperm production.
- A special X-ray to check for blockages in the vas deferens tubes and ejaculatory ducts.
- Sperm antibodies — steroid treatment used to be given to reduce antibody levels but these drugs can have nasty side-effects. Another option is to wash the sperm in a centrifuge to remove the antibodies, but this is difficult to do.
- Surgery to correct hypospadias, remove blockages in the testicles, or remove varicoceles.
- Antibiotics for infections.
- Hormonal treatments, e.g. clomiphene, are sometimes used where there's a low sperm count with no obvious explanation.
- Medication for some ejaculation problems, e.g. to tighten the bladder neck in cases of retrograde ejaculation, a problem that can sometimes arise after prostate surgery.
- Erectile dysfunction — the cause is physical in the majority of cases and can usually be successfully treated.
- Vasectomy reversal is successful in at least one in three men but success rates fall if reversal is carried out ten years or more after vasectomy.
- Vitamin E supplements (600 mg daily for three months) may improve sperm quality, but only if you have excessive amounts of naturally occurring molecules called free radicals — this affects one in five men with sperm problems. The molecules are thought to harden the sperm's outer membrane, making fusion with the egg more difficult.
- Assisted conception techniques are being increasingly used to treat male infertility, and they help by allowing sperm to bypass various barriers. Trapped sperm can be extracted either direct from the testis by a procedure called testicular sperm extraction or from the epididymis (the coiled tubes outside the testes that store sperm) using a needle by percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA). the collected sperm can be sued to fertilse the egg by ICSI (see below).
- IUI (intrauterine insemination) has been available for a long time now and can work well if you've got mild sperm problems. The best sperm are selected and then placed in your partner's womb. It's likely she'll be given hormonal drugs to increase the egg harvest and the chances of a pregnancy. IVF (in vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection) are also options.
- Donor insemination using another man's sperm.
How can I help myself?
Finding out that you may have some sort of fertility problem can wreak havoc with your sense of identity. It's common to feel defective, a failure, and that your partner has every right to go off and find someone who "works properly". When dealing with a fertility problem it's also easy to fall into the trap of believing that it's your partner who needs all the support, while you must be strong and silent.
- Don't bottle up your feelings and decide that you're a failure — you're not! Try talking to your partner about how you feel — you may find that this helps both of you. It may also help to see a fertility counsellor.
- Talking to other men in the same boat and discovering that you're not alone can also be a great help.
- If you need treatment try and go to a clinic which specialises in male infertility.
- Make sure that your lifestyle is as healthy as possible.
It's increasingly bright since the arrival of assisted conception techniques and as more becomes known about the causes of male infertility.
BICA (British Infertility Counselling Association)
69 Division Street, Sheffield S1 4GE (Tel: 0114 263 1448)
Infertility Network UK
Charter House, 43 St Leonards Road, Bexhill on Sea, East Sussex TN40 1JA (Tel: 08701 188 088)
Donor Conception Network
PO Box 7471, Nottingham NG3 6ZR (Tel: 0208 245 4369)
Book: Leslie R Schover and Anthony Thomas, Overcoming Male Infertility (John Wiley and Sons Ltd)
First drafted by Mary-Claire Mason
Page created on January 1st, 2005
Page updated on September 23rd, 2010