What Is Male Infertility?
Fertility refers to people's ability to reproduce by natural means.
Male infertility is when a man has a poor chance of making his female partner pregnant. It usually depends on the quality of his sperm cells.
Low sperm count
A low sperm count, also called oligozoospermia, is where a man has fewer than 20 million sperm per millilitre of semen. Having a low sperm count can make it more difficult to conceive naturally, although successful pregnancies can still occur.
Problems with sperm, including a low sperm count and problems with sperm quality, are quite common. They're a factor in around 1 in 3 couples who are struggling to get pregnant.
There are available treatments that can help you become a dad if you have a low sperm count.
Causes of low sperm count
The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce male sexual hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production.
Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.
However, often the cause of low sperm count isn't identified.
Medical causes
Low sperm count can be caused by a number of health issues and medical treatments.
Some of these include:
- Varicocele: A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it might be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
- Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea, syphilis or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
- Ejaculation problems: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation or lack of ejaculation, including diabetes, spinal injuries, prostate inflammation or enlargement, surgery of the bladder, inflammation of urethra.
Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some ejaculatory problems can be reversed, while others are permanent. In most cases of permanent ejaculation problems, sperm can still be retrieved directly from the testicles. - Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
- Tumors Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. Surgery, radiation or chemotherapy to treat tumors also can affect male fertility.
- Undescended testicles: During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
- Hormone imbalances: The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.
- Defects of tubules that transport sperm: Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
- Chromosome defects: Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.
- Celiac disease: A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
- Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications, and other medications can impair sperm production and decrease male fertility.
- Prior surgeries Certain surgeries might prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.
Environmental causes
Sperm production or function can be affected by overexposure to certain environmental elements, including:
- Industrial chemicals Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
- Heavy metal exposure: Exposure to lead or other heavy metals also can cause infertility.
- Radiation or X-rays: Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles: Elevated temperatures impair sperm production and function.Although studies are limited and are inconclusive, frequent use of saunas or hot tubs might temporarily impair sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.
The following aspects of sexual function and semen quality may affect fertility:
- Libido: Otherwise known as sex drive, libido describes a person's desire to have sex. Foods or supplements that claim to increase libido are called aphrodisiacs.
- Erectile dysfunction: Also known as impotence, erectile dysfunction is when a man is unable to develop or maintain an erection.
- Sperm count: An important aspect of semen quality is the number or concentration of sperm cells in a given amount of semen.
- Sperm motility: An essential function of healthy sperm cells is their ability to swim. Sperm motility is measured as the percentage of moving sperm cells in a sample of semen.
- Testosterone levels: Low levels of testosterone, the male sex hormone, may be responsible for infertility in some men.
Symptoms of low sperm count
The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some men, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms.
Low sperm count symptoms might include:
- Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Decreased facial or body hair or other signs of a chromosome or hormone abnormality
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:
- Erection or ejaculation problems, low sex drive, or other problems with sexual function
- Pain, discomfort, a lump or swelling in the testicle area
- A history of testicle, prostate or sexual problems
- A groin, testicle, penis or scrotum surgery
Risk factors of low sperm count
A number of risk factors are linked to low sperm count and other problems that can cause low sperm count.
They include:
- Using certain illicit drugs
- Being overweight
- Being severely depressed or stressed
- Having certain past or present infections
- Being exposed to toxins
- Overheating the testicles
- Having experienced trauma to the testicles
- Being born with a fertility disorder or having a blood relative, such as your brother or father, with a fertility disorder
- Having certain medical conditions, including tumors and chronic illnesses
- Undergoing cancer treatments, such as radiation or chemotherapy
- Taking certain medications
- Having a prior vasectomy or major abdominal or pelvic surgery
- Having a history of undescended testicles
Getting your sperm count checked
See our doctor's if you have not managed to conceive after 1 year of trying for a baby.
It's a good idea for both you and your partner to get advice, as fertility problems can affect men and women and often it's a combination of both. It's important to understand what the exact issue is before you decide on your next steps.
One of the tests your our doctor's can arrange is a semen analysis.
This is where a sample of semen is analyzed to check the quality and quantity of the sperm. The results in our clinic usually available during 2 hours.
If the results are not normal, you need to see our doctors, follow their professional advice.
Home sperm count testing kits
There are steps you can take at home to increase your chances of getting your partner pregnant, including:
- Increasing the frequency of sex: Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
- Having sex when fertilization is possible: A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
- Avoiding lubricants: Some products such as cream, jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.
Diagnosis
When you see our doctor's because you're having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if our doctor's thinks low sperm count is the problem, it is recommended that your partner be evaluated to rule out potential contributing factors and determine if assisted reproductive techniques may be required.
Testing and diagnosis may involve the following:
General physical examination and medical history
Semen analysis
A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer might be used to measure sperm count.
Semen samples can be obtained in a couple of different ways. You can provide a sample by masturbating and ejaculating into a special container at the doctor's office. Because of religious or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, semen can be collected by using a special condom during intercourse.
To ensure accuracy in a collection, our doctor's will:
- Ask you to make sure all of your semen makes it into the collection cup or collection condom when you ejaculate
- Have you abstain from ejaculating for at least 4 days before collecting a sample
- Have you avoid the use of lubricants because these products can affect sperm motility
Semen analysis results
Normal sperm densities range from 20 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 20 million sperm per milliliter or low characteristics of motility or morphology.
Your chance of getting your partner pregnant decreases with decreasing sperm counts. Some men have no sperm in their semen at all. This is known as azoospermia.
There are many factors involved in reproduction, and low sperm count is only one of it. Some men with normal sperm counts unable father children, in this case necessary to take attention to sperm quality like movement (motility) and aglutation.
Other tests:
- Scrotal ultrasound: This test uses high-frequency sound waves to look at the testicles and supporting structures.
- Hormone testing: Your doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
- Post-ejaculation urinalysis: Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
- Genetic tests: When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.
- Testicular biopsy: This test involves removing samples from the testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport. However, this test is typically only used in certain situations and is not commonly used to diagnose the cause of infertility.
- Anti-sperm antibody tests: These tests, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function, are not common.
- Specialized sperm function tests: A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. These tests are rarely performed and often do not significantly change treatment recommendations.
- Transrectal ultrasound: A small lubricated wand is inserted into your rectum to check your prostate and check for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Keep trying
Your doctor may initially suggest trying to conceive naturally for a little longer. Many couples conceive within the second year of trying.
- You can having sex every 2 or 3 days
- staying in good shape, exercising regularly and having a healthy balance diet
- Surgery: For example, a varicocele can often be surgically corrected or an obstructed vas deferens can be 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: Antibiotics can cure an infection of the reproductive tract, but this 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: Our 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.
Preventive measures for low sperm count
To protect your fertility, avoid known factors that can affect sperm count and quality.
For example:
- Talk to your doctor about medications that can affect sperm count.
- Maintain a healthy weight.
- Avoid heat.
- Manage stress.
- Avoid exposure to pesticides, heavy metals and other toxins.
