Up to 15 percent of couples are infertile. This means they aren’t able to conceive a child even though they’ve had frequent, unprotected sexual intercourse for a year or longer. In up to half of these couples, male infertility plays a role.
Symptoms
Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:
- Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Recurrent respiratory infections
- Inability to smell
- Abnormal breast growth (gynecomastia)
- Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
- Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
When to see a doctor
See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:
- Have erection or ejaculation problems, low sex drive, or other problems with sexual function
- Have pain, discomfort, a lump or swelling in the testicle area
- Have a history of testicle, prostate or sexual problems
- Have had groin, testicle, penis or scrotum surgery
Risk factors
Risk factors linked to male infertility include:
- Smoking tobacco
- Using alcohol
- Using certain illicit drugs
- Being overweight
- Having certain past or present infections
- Being exposed to toxins
- Overheating the testicles
- Having experienced trauma to the testicles
- Having a prior vasectomy or major abdominal or pelvic surgery
- Having a history of undescended testicles
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
- Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer
Complications
Infertility can be stressful for both you and your partner. Complications of male infertility can include:
- Surgery or other procedures to treat an underlying cause of low sperm count or other reproductive problems
- Expensive and involved reproductive techniques
- Stress and relationship difficulties related to the inability to have a child
Tests and diagnosis
Many infertile couples have more than one cause of infertility, so it’s likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified.
Infertility tests can be expensive and might not be covered by insurance — find out what your medical plan covers ahead of time.
Diagnosing male infertility problems usually involves:
- General physical examination and medical history.
- Semen analysis.
Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
- Scrotal ultrasound.
- Hormone testing.
- Post-ejaculation urinalysis.
- Genetic tests.
- Testicular biopsy.
- Specialized sperm function tests.
- Transrectal ultrasound.
Treatments and drugs
Treatments for male infertility include:
- Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
- Treating infections. Antibiotic treatment might cure an infection of the reproductive tract, but doesn’t always restore fertility.
- Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
When treatment doesn’t work
In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child. Your doctor might suggest that you and your partner consider using sperm from a donor or adopting a child.
Lifestyle and home remedies
There are a few steps you can take at home to increase your chances of achieving pregnancy:
- Increase frequency of sex. Having sexual intercourse every day or every other day beginning at least 4 days before ovulation increases your chances of getting your partner pregnant.
- Have sex when fertilization is possible.
- Avoid the use of lubricants.
Prevention
Many types of male infertility aren’t preventable. However, you can avoid some known causes of male infertility. For example:
- Don’t smoke.
- Limit or abstain from alcohol.
- Steer clear of illicit drugs.
- Keep the weight off.
- Don’t get a vasectomy.
- Avoid things that lead to prolonged heat for the testicles.
- Reduce stress.
- Avoid exposure to pesticides, heavy metals and other toxins.