If you and your partner have been trying to conceive for more than one year unsuccessfully, you may want to consult with your doctor about the possible reasons behind your struggle. While many couples tend to assume their fertility problems are female-related, in fact, up to 40 percent of fertility issues are due to male factor infertility. There are many factors that might lead to a man’s infertility, though some are more common than others. They include abnormal sperm production or function, impaired delivery of sperm, conditions related to health and lifestyle, and overexposure to certain elements. These potential causes are listed in further detail below.
Varicocele
One of the most common causes of male infertility is a varicocele, affecting approximately 40 percent of infertile men. A varicocele occurs when the veins in the scrotum are enlarged on one or both sides, which causes the temperature of the scrotum to increase and affects both the production and quality of sperm. There are no symptoms associated with varicocele, but a physical exam and semen analysis can help diagnose the problem. About 30 to 35 percent of men go on to impregnate their partners after undergoing surgery to repair the varicocele.
Sperm Disorders
Problems with the production and maturation of sperm are other common causes of male infertility. Sperm may be immature, abnormally shaped, or unable to move properly, while normal sperm may be produced in abnormally low numbers (oligospermia) or seemingly not at all (azoospermia). Sperm disorders can be caused by many factors, including infectious diseases, inflammatory conditions, endocrine or hormonal disorders, immunological disorders, genetic diseases and environmental and lifestyle factors.
Blocked tubes
Some men are born with blockage of the vas deferens or the epididymis, the part of the testicle that contains sperm, which prevents a man’s sperm from reaching his partner’s egg. Blockage may also occur for a variety of other reasons, including prior vasectomy, injury, scarring from sexually transmitted disease or anatomical defects. A surgical procedure may be done to clear the blockage and about 50 to 80 percent of men have sperm in their semen following the surgery. Many men with blocked tubes elect to undergo fertility treatments such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) following corrective surgery to improve their chances of impregnating their partners. About 25 to 40 percent of couples conceive following these treatments.
Heat
When the temperature of a man’s testicles (where sperm is produced) increases, it can greatly reduce the number of sperm and the strength of sperm movement, as well as increase the number of abnormal sperm he produces. Conditions which can raise the temperature of the testicles may include exposure to excessive heat or heat over an extended period of time, prolonged fever, varicocele, or contact with heated objects like saunas, hot tubs and heating blankets. It is generally believed that sperm recover quickly from heat exposure, so a man’s sperm count should return to normal within about a week.
Erectile Dysfunction
When a man has trouble getting or maintaining an erection, he will have a difficult time releasing any sperm. Erectile dysfunction and the inability to ejaculate may occur as a result of many underlying causes, including diabetes, prostate surgery, urethra surgery, hypertension and heart disease.
Retrograde Ejaculation
Sometimes sperm moves in the wrong direction. Instead of forward and out through the penis, sperm is transported backwards into the bladder. This condition is known as retrograde ejaculation and it is occurs when the nerves or muscles in the bladder do not work properly. Retrograde ejaculation is more common among men who have diabetes, who have had prostate surgery, or who take certain medications.
Other Causes
There are several other factors that can lead to male infertility. Certain hormonal disorders, such as hyperprolactinemia, hypothyroidism and disorders of the adrenal or pituitary gland, may interfere with sperm production. Types of infections, such as mumps or certain sexually transmitted diseases (STDs), can cause sterility or low sperm counts. Other diseases, particularly when not controlled, such as diabetes, hypertension and cystic fibrosis, can also cause problems with sperm production, as can injuries to the testicles. In addition, environmental or work hazards and the use of certain medications, steroids, recreational drugs and alcohol can lead to fertility problems in men. In other cases, the cause of a man’s infertility cannot be identified, which may point to underlying genetic problems, like an abnormality of the sex chromosomes.
Treatment
There is a range of treatment options available for the various causes of infertility in men, which include surgery, drug therapy, and assisted reproductive technologies (ART), such as artificial insemination, in vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT). If you and your partner are having fertility issues, it is important that you are both evaluated by a doctor in order to pinpoint the problem and rule out other possible causes. A thorough physical exam and a semen analysis may be able to determine if your partner is the source of the issue. Then, depending on the cause of his infertility, his age, overall health and medical history, the doctor or reproductive endocrinologist will determine the best treatment.