Definition & Overview

Male infertility is a medical condition that lowers a male patient’s chances of getting a female partner pregnant.

In normal circumstances, a man releases sperm through sexual ejaculation. The sperm then makes it way through the epididymis, a tube behind each testicle, and through the vas deferens going to the ejaculatory duct in the pelvis. Some cases of male infertility originate from sperm production (or the point at which the sperm is produced), while some are related to problems in sperm delivery. Genetic factors, hormone levels, and other factors also come into play. Treatment for the condition, which may involve the use of medications and surgical procedures, depends on the actual causes.

Who Should Undergo and Expected Results

A male patient is considered infertile when he fails to get a female partner pregnant after a year of unprotected sex.

The condition is more common among men over the age of 30. Statistics show that 13 out of 100 couples have difficulty conceiving and that in over a third of these cases, the problem originates from the male partner.

These patients tend to suffer from the following symptoms:

  • Difficult ejaculations
  • Ejaculating small volumes of fluid
  • Reduced sexual libido
  • Erectile dysfunction, or having difficulty maintaining erections
  • Pain in the testicle area
  • Abnormal lump in the testicle area
  • Swelling in the testicle area
  • Reduced or compromised ability to smell
  • Gynaecomastia or abnormal breast growth
  • Decreased body hair, which may indicate either a chromosomal or a hormonal problem
  • Low sperm count, the normal of which should be 15 million sperm per millilitre of semen or 39 million sperm per ejaculation


In order for a man to get his female partner pregnant, several conditions must be in place:

  • The sperm produced must be healthy, functional, and able to move normally; any abnormalities in the function or movement of the sperm may hinder it from reaching or penetrating the female egg
  • Sperm should be able to mix successfully with semen
  • The quantity of sperm in the semen should be adequate


The possible causes of male infertility include:

  • Conditions that cause low sperm production, such as varicocele or when the veins that drain in the testicle become swollen. This is the most common but reversible cause of male infertility.
  • Abnormal sperm function or ejaculation issues
  • Retrograde ejaculation, or when the semen enters the bladder instead of coming out from the penis
  • Blockages in the tubes where the sperm pass through
  • Scarring in the tubes
  • Epididymitis or inflamed epididymis
  • Orchitis or inflamed testicles
  • Underlying medical conditions
  • Diabetes
  • Tumours, both malignant and benign, affecting the male reproductive organs
  • Hormone imbalances
  • Celiac disease
  • Hypospadias
  • Certain infections, some of which may cause permanent damage to the testicles
  • Gonorrhea
  • HIV
  • Congenital structural problem affecting the testicles
  • Undescended testicles
  • Klinefelter’s syndrome, or when a man is born with 2 X chromosomes and 1 Y chromosome
  • Cystic fibrosis
  • Kallman’s syndrome
  • Kartagener’s syndrome
  • Injury to the pelvic region or spine
  • Previous surgery in the groin, testicle, penis, or scrotum
  • Negative lifestyle habits, such as illicit drug use, alcohol abuse, and tobacco smoking
  • Obesity
  • Severe and prolonged emotional stress that affects hormone levels
  • Certain medications and medical procedures, such as:
  • Chemotherapy and radiation therapy
  • Long term use of anabolic steroids
  • Testosterone replacement medications
  • Certain antifungal medications
  • Exposure to industrial chemicals and heavy metals
  • Frequent exposure to x-ray or radiation
  • Elevated temperatures affecting the testicles that may be caused by:
  • Frequent use of saunas
  • Tight clothing


The process of treating male infertility typically begins by diagnosing the causes of the problem as well as other contributing factors so that a targeted treatment plan, which is customised based on each patient's specific circumstances, can be formulated.

The end goal of the treatment is to help the patient to successfully conceive a child with his female partner.

How is the Procedure Performed?

Male infertility treatment begins with several diagnostic tests, including:

  • Physical examination
  • Sperm and semen analysis
  • Hormone evaluation
  • Testicular biopsy
  • Genetic testing


Once the possible causes and contributing factors are determined, a treatment plan is formulated and may include any or a combination of the following:

  • Surgery – Anatomical problems affecting the testicles and the tubes through which sperm passes, as well as obstructions and varicoceles, can be treated with surgery.
  • Hormonal therapy, such as gonadotropin treatment to improve blood testosterone levels or clomiphene treatment
  • Lifestyle changes, such as smoking cessation and reduced consumption of alcohol and other addictive substances
  • Stress relief therapy
  • Antibiotic or antimicrobial therapy for infections
  • Dietary supplements and vitamins


In the event that the above treatments fail to work, the patient may choose to use assisted reproductive techniques (ARTs) to conceive a child. These include IVF (in-vitro fertilisation) and IUI (intrauterine insemination).

Possible Risks and Complications

Most treatment options, either those used to treat an underlying condition or the actual cases of male infertility, come with certain risks. Hormone therapy drugs, for example, are linked to:

  • Acne
  • Breast enlargement
  • Dizziness
  • Headache
  • Nausea
  • Vision changes
  • Weight gain


Meanwhile, surgery is linked to bleeding, infection, and adverse reactions to the anaesthetics used during the procedure.

References:

  • Faraj K. “Male Infertility Treatment and Management.” Medscape. http://emedicine.medscape.com/article/436829-overview Anawalt BD. “Approach to male infertility and induction of spermatogenesis.” J Clin Endocrinol Metab. 2013 Sep; 98(9):3532-3542. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763976/

  • Cocuzza M., Agarwal A. “Nonsurgical treatment of male infertility: specific and empiric therapy.” Biologics. 2007 Sep; 1(3): 259-269. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721319/

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