Infertility can be an uncomfortable puzzle for couples trying to conceive, and male partners feel the stress just as much as women do. When a couple has trouble getting pregnant, it’s often assumed that the root cause is on the woman’s side. But did you know that fertility issues in men are just as common as they are in women?
The good news is that fertility problems in men are often treatable. Here’s a closer look at the issues that can affect a man’s ability to conceive with his partner, how male infertility is diagnosed and what couples can do about it.
What is male infertility?
Male infertility is defined as when a man is unable to conceive with his partner after at least a year of trying. And the problem is more common than you might think.
In about a third of all infertility cases, the cause is traced back to the man, while another third of cases can be traced back to the woman. The rest of the time the cause is unknown, or may be a combination of factors between both partners.
What are the possible causes of male infertility?
Male infertility can result when:
- A man’s body doesn’t produce enough sperm
- Sperm doesn’t function normally
- A blockage prevents sperm from getting to the egg
Low sperm production or motility may stem from an underlying health issue. Often it’s anatomical, as in the case of varicocele — an enlarged vein in the testicle that causes a man to make less sperm, a condition affecting 40 percent of men with infertility problems.[1] But untreated chronic diseases like diabetes or thyroid problems can also be culprits.
Taking certain drugs may impact a man’s sperm too. Testosterone therapy, steroid use and certain cancer treatments and drugs can all have a negative effect on sperm production and motility. So can specific medications, including flutamide, cyproterone and bicalutamide for prostate cancer, spironolactone for high blood pressure, cimetidine for ulcers and acid reflux, and ketoconazole, an antifungal drug.
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Certain lifestyle factors are thought to play a role. Obesity, smoking, excessive drinking or marijuana use can all negatively impact sperm. Same with frequently exposing the testicles to too-warm temperatures, by, say, spending lots of time cycling or hanging out in a sauna. Frequent exposure to environmental toxins like lead or pesticides can also have an effect.
Despite all this, the question of what causes male infertility doesn’t always have an answer. In about half of all cases, experts aren’t able to figure out why a man can’t get his partner pregnant.
Who's at risk for male infertility?
Any man can be affected by infertility, even if he’s already fathered a child. Still, fertility is more likely to be an issue for men who:[2]
- Have an anatomical problem that affects the reproductive system, like varicocele
- Have a hormonal imbalance, like a thyroid problem
- Take testosterone therapy or anabolic steroids
- Have an uncontrolled chronic disease
- Have immune or auto-immune problems
- Are obese
- Are over the age of 40
- Are undergoing radiation for cancer treatments, or are taking certain medications to treat prostate cancer
- Smoke cigarettes, use marijuana or drink excessive amounts of alcohol
- Are frequently exposed to environmental toxins such as pesticides, lead, cadmium or mercury
- Are frequently exposed to excess heat around the testicles from things like sauna use or intense bicycling
How is male infertility diagnosed?
After discussing your specific health and fertility profile with you, a doctor may recommend a semen analysis, which looks at a man’s sperm count (concentration), sperm shape (morphology) and how efficiently the sperm move (motility). The test itself is pretty simple: A man ejaculates into a cup, and a laboratory specialist examines the sperm in the man's semen.
A semen analysis can tell whether there are problems with a man’s sperm that could affect his fertility.[3] But it’s just a first step, since the test can’t usually tell you what’s actually causing the problem with the sperm.
For that, the doctor might recommend more specific testing — like a hormone analysis, a scrotal ultrasound or a testes biopsy. If an underlying cause can be determined, treating that issue will often improve a man’s fertility.
How does male infertility affect your ability to get pregnant?
Fertilization is a pretty complex process, but it ultimately boils down to a man’s sperm being able to penetrate a woman’s egg. That can be harder to achieve if a man doesn’t produce enough sperm, his sperm don’t swim well or the sperm are abnormally shaped.
If a man doesn’t produce any sperm at all, he won’t be able to get a woman pregnant. In that case, a couple could consider trying assisted reproductive therapies like IVF using donor sperm.
Can you still conceive if you’re dealing with male infertility?
As long as a man produces some amount of sperm, there’s a chance he could get a woman pregnant. In fact, some couples dealing with low sperm counts or abnormal sperm are still able to conceive without any additional interventions.
But others might need help in the form of fertility treatments. If you and your partner haven’t been able to get pregnant after trying for a year, consult with your doctors. (Couples where the woman is over 35 should see their doctors after six months of trying.)
What are the possible treatments for male infertility?
There are lots of options, depending on the underlying cause of the infertility:
- Surgery might be the best option for infertility related to anatomical problems like varicocele.
- Medication can often be used to treat other health problems, like a thyroid disorder or uncontrolled diabetes.
- Assisted reproductive therapies like intrauterine insemination or in vitro fertilization can be used when the underlying cause of a man’s infertility is unknown. If a man can’t use his own sperm, using donor sperm is another option.
Lifestyle changes like losing weight, quitting smoking, cutting back on alcohol or marijuana use or stopping medications known to affect fertility can all make a difference too. But it’s best for men to take these steps proactively, before he and his partner start trying to get pregnant.
Can you get pregnant if you’re dealing with male infertility, or will you always need help conceiving?
Surgery, medication and assisted reproductive therapies can all help couples get pregnant. A fertility specialist can recommend the best treatment options based on the underlying cause of the infertility.
As for whether you’ll need help conceiving if you want to get pregnant a second time, that, too, depends on the fertility’s underlying cause. If a specific health issue that’s affecting a man’s fertility gets cleared up, he might not have a problem conceiving in the future. But if the cause of his infertility is unknown, he may or may not run into problems next time.
Male infertility is complicated because there are so many different possible causes. The good news is that many couples who experience male infertility issues are still able to conceive. If you and your partner are concerned that male infertility might be an issue for you, talk with your doctor. Together you can figure out the best plan for trying to get pregnant.
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