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Male infertility

Alternative Names
infertility due to male factors

Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Male infertility means the male is unable to impregnate the female because of male factors.

What is going on in the body?
The inability to get pregnant may be caused by conditions in either partner. It is estimated that 30% of infertility is caused by male factors, 30% is caused by female factors, and 40% is caused by a combination of female and male factors.

What are the signs and symptoms of the condition?
The primary sign of male infertility is that the man's partner does not conceive after one year of attempting to become pregnant. Other signs and symptoms depend on the underlying cause of the man's infertility.

What are the causes and risks of the condition?
Some of the factors that cause male infertility include:
  • varicocoele, a group of enlarged veins inside the scrotum
  • vasectomy, a surgical procedure in which the tubes that carry the sperm from the testes are surgically tied off
  • problems with semen, including low sperm count, poor sperm quality, and poor movement of sperm
  • certain systemic, or bodywide, diseases. Male infertility can be linked to diabetes, cancer, liver disease, kidney disease, and mumps.
  • genital infections such as gonococcal infections, tuberculosis, and genital herpes
  • infections of the reproductive organs, such as prostatis and epididymitis
  • exposure to environmental hazards such as lead, pesticides, radiation, and heavy metals such as mercury
  • undescended testicles, a condition in which the testes fail to drop into the scrotum from the abdomen during the development of the foetus. When the testicles remain inside the abdomen, their temperature is higher and fewer sperm are made.
  • surgery of the reproductive system such as transurethral resection of the prostate or simple prostatectomy
  • inherited conditions that impair the ability to produce sperm, such as Down syndrome
  • side effects of treatments for testicular cancer or prostate cancer. Treatments can include radiation therapy, chemotherapy, or the removal of one or both testicles.
  • injury to the testicles
  • some autoimmune disorders, which can cause the immune system to produce antibodies that attack and weaken sperm
  • sexual problems such as erectile dysfunction and premature ejaculation
  • hormone imbalances that impair the body's ability to make hormones needed for normal semen production and sexual functioning
  • certain drugs, such as alcohol and marijuana
  • certain medications, such as anabolic steroids, chemotherapy medications, and cimetidine, which is used to treat gastrooesophageal reflux
  • exposure to diethylstilbesterol (DES) as an infant in utero. DES is a medication that was previously used to prevent miscarriage.
  • frequent hot baths or use of hot tubs, which raise the temperature inside the testicles and reduce the body's ability to produce healthy sperm
  • wearing tight-fitting pants and underwear, which also raises the temperature inside the testicles
  • excessive exercise, which increases adrenal steroid hormones. Excess steroid hormones lower testerone levels and decrease sperm production.
A recent study has found that baby boys who wear nappies lined with plastic have significantly higher temperatures inside the testicles. While more research is needed in this area, the authors of the study suggest that the use of disposable nappies may be one of the causes of the increase in male infertility over the past 25 years.

What can be done to prevent the condition?
Some cases of male infertility may be avoided by:
  • having regular physical examinations to detect early signs of infections or abnormalities that may lead to infertility
  • wearing protection over the scrotum during athletic activities to prevent injury
  • getting early treatment for sexually transmitted diseases
  • avoiding excessive exercise
  • avoiding tight underwear or pants
  • avoiding exposure to environmental hazards such as pesticides and heavy metals, for example, mercury, copper, lead, and aluminum
  • avoiding frequent hot baths or use of hot tubs
  • controlling systemic diseases, such as diabetes and hormone imbalances
  • avoiding drugs and medications known to cause fertility problems
Although more research needs to be done on the connection between higher temperatures inside the testicles of baby boys and infertility later in life, parents may want to consider alternatives to disposable nappies for male infants.

How is the condition diagnosed?
The first step in diagnosing the cause of male infertility is a complete medical history and physical examination. If the cause is not obvious, a blood test to look at hormone levels and a semen sample may be needed. The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed. Other tests may be needed in some cases. For example, if cancer or a tumour is the cause of the problem, a special X-ray may be needed to locate the cancer.

What are the long-term effects of the condition?
Male infertility can create tension in a couple's relationship. Sexual relations may become less pleasurable. Determining the cause of infertility and treating this condition can be expensive. Eventually, 85% of couples find a cause for their inability to conceive. However, some couples never become pregnant even with the newest treatments. Adoption may be the best choice in some cases.

What are the risks to others?
Male infertility is not contagious. However, male infertility can be caused by a sexually-transmitted disease, which may be transmitted to sexual partners.

What are the treatments for the condition?
Treatment of male infertility focuses on the underlying cause. Without treatment, 15% to 20% of infertile couples will eventually get pregnant. Treatment for a male with infertility may include:
  • learning about the best times to conceive
  • making lifestyle changes, such as smoking cessation and limiting intake of alcohol
  • eating a healthy diet and exercising in moderation
  • treating erectile dysfunction with counselling, medication, or surgery
  • wearing loose-fitting underwear, such as boxer shorts
  • avoiding extended periods of time in hot baths and hot tubs
  • taking antibiotics for any diagnosed infection
  • taking hormone therapy
  • having vasectomy reversal surgery, which reconnects the tubes carrying sperm from the testes
  • having a varicocoele surgically repaired
  • using in vitro fertilisation. In this procedure, the woman's egg is fertilised outside the womb and then returned to the uterus.
  • using intracytoplasmic sperm injection to place individual sperm cells directly inside the woman's eggs. This technique is used when there is very low sperm count or poor sperm movement.
  • using artificial insemination, which involves placing sperm directly in the cervix or in the uterus
What are the side effects of the treatments?
Complications of surgery can include bleeding, infection, and allergic reactions to anaesthesia. In vitro fertilisation increases the chance of having a multiple pregnancy, such as twins or triplets. Antibiotics and other medications may cause stomach upset, diarrhoea, or an allergic reaction.

What happens after treatment for the condition?
Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

How is the condition monitored?
The man can monitor his own ability to impregnate a woman.

Author: Gail Hendrickson, RN, BS
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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