Symptoms & causes
Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive. Male infertility is diagnosed when, after testing of both partners, reproductive problems have been found in the male partner.
How common is male infertility?
Infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner (male infertility).
Are there any signs or symptoms of male infertility?
In most cases, there are no obvious signs of an infertility problem. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
How does the male reproductive system work?
The male reproductive tract is made up of the testes, a system of ducts (tubes) and other glands opening into the ducts.
The testes (testis: singular) are a pair of egg shaped glands that sit in the scrotum next to the base of the penis on the outside of the body.
Each normal testis is 15 to 35ml in volume in adult men. The testes are needed for the male reproductive system to function normally. The testes have two related but separate roles:
- production of sperm
- production of the male sex hormone, testosterone.
What causes male infertility?
Male infertility can be caused by problems that affect sperm production or the sperm transport process. With the results of medical tests, the doctor may be able to find a cause of the problem.
Known causes of male infertility can be:
Sperm production problems: The most common cause of male infertility is due to a problem in the sperm production process in the testes. Low numbers of sperm are made and/or the sperm that are made do not work properly. About two thirds of infertile men have sperm production problems.
Blockage of sperm transport: Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.
This is the second most common cause of male infertility and affects about one in every five infertile men, including men who have had a vasectomy but now wish to have more children.
Sperm antibodies: In some men, substances in the semen and/or blood called sperm antibodies can develop which can reduce sperm movement and block egg binding (where the sperm attaches to the egg) as is needed for fertilisation.
About one in every 16 infertile men has sperm antibodies.
Sexual problems: Difficulties with sexual intercourse, such as erection or ejaculation problems, can also stop couples from becoming pregnant. Sexual problems are not a common cause of infertility.
Hormonal problems: Sometimes the pituitary gland does not send the right hormonal messages to the testes. This can cause both low testosterone levels and a failure of the testes to produce sperm.
Hormonal causes are uncommon, and affect less than one in 100 infertile men. Unfortunately, medical scientists do not yet understand all the details of sperm production and the fertilisation process. As a result, for many men with a sperm production problem, the cause cannot be identified.
Known causes of male infertility
|Sperm production problems||• Chromosomal or genetic causes
• Undescended testes (failure of
the testes to descend at birth)
• Torsion (twisting of the testis in scrotum)
• Varicocele (varicose veins of the testes)
• Medicines and chemicals
• Radiation damage
• Unknown cause
|Blockage of sperm transport||• Infections
• Prostate related problems
• Absence of vas deferens
|Sperm antibodies||• Vasectomy
• Injury or infection in the epididymis
• Unknown cause
(erection and ejaculation problems)
|• Retrograde and premature ejaculation
• Failure of ejaculation
• Infrequent intercourse
• Spinal cord injury
• Prostate surgery
• Damage to nerves
• Some medicines
|Hormonal problems||• Pituitary tumours
• Congenital lack of LH/FSH
(pituitary problem from birth)
• Anabolic (androgenic) steroid abuse
If a couple has been trying to get pregnant without success, they should go to their local doctor, family planning or women’s health clinic where initial tests can be performed. Both partners should be tested, even if one has already had a child in another relationship.
Diagnosis can involve a medical history from the man to find out whether there are any obvious health problems that could affect fertility.
- A physical examination is done, along with a semen analysis to check the number, movement and shape of the sperm in the ejaculate.
- Blood tests may also be done to check the hormone levels that control sperm production.
- Genetic investigations and testicular biopsies are sometimes done.
When the cause of the male infertility problem can be treated, a couple can try to achieve a pregnancy naturally. Many men will still be able to father children naturally even though they may have a lowered sperm count.
Treatable causes of male infertility include:
- blockages of sperm transport (for example, vasectomy)
- hormone problems
- some sexual problems (for example, problems with getting and keeping an erection)
- some reversible conditions (for example, use of anabolic steroids).
In some cases, the doctor will recommend that the couple seek assisted reproductive technologies (such as IVF) in order to become pregnant. These techniques do not cure or treat the cause of the male infertility problem, but they may help the couple conceive even if the man’s sperm count is very low.
Male infertility is completely untreatable when a man has no sperm in his semen (azoospermia) or in the testes, because the sperm producing cells in the testes either did not develop or have been permanently destroyed. The only options for such couples who want to have a family are to think about adoption, foster parenting or donor insemination.
What is intracytoplasmic sperm injection (ICSI)?
ICSI is a form of IVF where a single sperm is injected directly into each egg by piercing the outer covering of the egg, and is particularly helpful for men with poor sperm production.
ICSI can achieve pregnancies even when only a few sperm are produced. Sperm are collected from the semen or removed carefully from the testis or epididymis. If a couple decides to go ahead with ICSI, it should be remembered that these assisted reproductive technologies expose women to risk, such as those associated with surgical collection of eggs, and switches the focus from the man to the woman.
Management & support
Can male infertility be prevented?
Cigarette smoking, alcohol, sexually transmitted diseases, heat stress from tight fitting underwear, and anabolic steroids (taken for body building or sporting purposes) can be harmful to the production of sperm and should be avoided.
Although there is no clear scientific research that some work environments affect fertility, it is generally recommended that couples trying to become pregnant avoid exposure to any possible harmful chemicals.
Pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm produced. For men who work in occupations that may affect fertility, it’s important to wear protective clothing and follow all occupational health and safety guidelines.
Is age important when trying to have a family?
Healthy men in their 70s and beyond can still father children, however the time taken to cause a pregnancy is longer from middle age onward. Reasons for this may include a decrease in sexual activity, semen volume, sperm motility (movement), the total number of motile sperm and possibly sperm function and DNA quality.
Some genetic and chromosomal problems in offspring also increase as the male age increases.
What emotions can a man experience when diagnosed with infertility?
Most men are shocked when they find out they are infertile. There is still a common but incorrect belief that infertility is a female condition. Therefore when men are told that there is a sperm problem, they are often quite unprepared. It is not unusual for men to feel stressed about an initial diagnosis of infertility.
Most infertile men at some time struggle with the idea that they are not able to do what other men can. This may lead men to confuse their infertility with their sense of masculinity, sexuality, virility and potency. An emotional response to infertility is normal.
Talking with a doctor and if needed a sexual therapist or a counsellor to work through these feelings can help some men at this difficult time.
More information and support
- AccessAustralia (Australia’s National Infertility Network) is a consumer-based, independent, non-profit organisation committed to being a national voice in promoting the well-being and welfare of infertile people.
- The Donor Conception Support Group provides support to couples thinking about accessing donor sperm, egg or embryo programs.
- Fertility Society of Australia (FSA) is the peak body representing scientists, doctors, nurses, consumers and counsellors in reproductive medicine in Australia & New Zealand. Infertility patient support groups are associated with many fertility or IVF clinics. Clinics are listed on the FSA website.
- Your Fertility provides information that aims to empower those who want children to make lifestyle choices that will help them conceive and have healthy babies. It is an initiative run by the Fertility Coalition: the Victorian Assisted Reproductive Treatment Authority (VARTA), Andrology Australia, Jean Hailes for Women’s Health and the Robinson Institute.