Written by: Dr. Brent Hanson, a reproductive endocrinology and infertility specialist at CCRM Fertility of Minneapolis
It still comes as a surprise to many that about half of cases of infertility are to due male fertility problems. The good news that male fertility is often treatable. If you and your partner are struggling to get pregnant, it’s important that both partners undergo fertility testing, so that concerns can be addressed right away.
Let’s explore five common reasons why male infertility occurs and potential treatments.
1. Concerns with sperm production or blockages
One of the most common causes of male infertility are related to sperm production. This can be caused by a number of factors including:
- Varicoceles: when the veins in the scrotum enlarge
- Undescended testicle(s)
- Trauma to the testicles
- Chromosomal abnormalities
The treatment for sperm production issues varies depending on the underlying cause. Treatment options can include a combination of the following: medications, surgery, lifestyle changes, and assisted reproductive technologies (ARTs), such in vitro fertilization (IVF).
Blockages are also a cause of male infertility. In order for pregnancy to occur, sperm need to travel from the testes out through the urethra in the penis. When there’s an obstruction anywhere along that pathway, there could be difficultly for conception to take place.
Obstructive azoospermia is when there’s no sperm in the semen. This usually happens after a vasectomy, but other reasons can include:
- Genetic mutations caused by cystic fibrosis
- Infections within the genital tract
- Previous surgeries, such as vasectomies
- Injury to the testicles or scrotum
Treatment for obstructive azoospermia includes surgery, such as a vasectomy reversal or sperm retrieval techniques such as:
- Testicular sperm extraction (TESE)
- Microsurgical epididymal sperm aspiration (MESA)
- Percutaneous epididymal sperm aspiration (PESA)
- Percutaneous testicular sperm extraction (TESA)
These techniques involve retrieving the sperm directly through the testis or epididymis and then are followed by IVF with intracytoplasmic sperm injection (ICSI), which is a procedure done in the laboratory in which a single sperm injected into an egg.
2. Testosterone use
There’s been a recent increase in the use of prescribed testosterone or anabolic steroids that contain testosterone in males. Testosterone can lower the levels that naturally occur in the body, leading to a drop in sperm counts and difficulty achieving pregnancy.
In some cases when testosterone is too low in the body, you might be prescribed medication to increase levels where sperm production isn’t affected. If you need to take testosterone, talk with your doctor if you’re planning a pregnancy.
3. Genetic conditions
Some problems with male fertility are due to genetic factors. Examples of genetic conditions that can impact male fertility include:
- Klinefelter syndrome
- Cystic fibrosis
- Y chromosome microdeletions
- Chromosomal translocations
Oftentimes, these conditions don’t have any symptoms and you may not even be aware there’s a concern. Treatment options for genetic condition that affect your fertility include:
- Remove sperm directly from the testicle (TESE)
- Use donor sperm
Your fertility specialist may recommend genetic testing after an abnormal semen analysis to help pinpoint genetic abnormalities.
4. Unexplained infertility
Sometimes sperm count, morphology, motility, or concentration may be slightly out of range on a semen analysis, however no specific reason for male infertility can be determined. This is referred to as “unexplained infertility.”
If you have abnormal semen analysis, it’s important to first figure out if there are any environmental exposures that could be affecting sperm such as:
- Using hot tubs or saunas on a regular basis: high temperatures can decrease sperm production
- Tobacco use: smoking cigarettes can lead to decreased sperm concentration, decreased motility (how sperm swim), fewer normally shaped sperm, and increased sperm DNA damage.
- Drug and/or alcohol use: can impact sperm count, size, shape and motility
- Exposure to chemicals or radiation: can potentially cause poor semen quality, low sperm count, low ejaculate volume, high number of morphologically abnormal sperms and low number of motile sperms.
- Weight gain: Increased weight in men has been associated with a lower testosterone level, poorer sperm quality, and reduced fertility as compared to men of normal weight.
Fortunately, the body is constantly creating new sperm and on average, it takes around 74 days to regenerate new sperm. With lifestyle changes and by eliminating environmental factors, it’s possible to improve the health of your sperm.
In some instances of unexplained infertility, fertility treatment options such as in vitro fertilization (IVF) can be successful.
5. Relationship and mental health concerns
Mental and emotional health have a strong impact on sex drive. Couples experiencing infertility or going through fertility treatments can be under a lot of stress. The pressure to have scheduled intercourse can result in erection difficulties, low libido, or difficulty in achieving orgasms. All of these can impact your timing for getting pregnant.
Some medications prescribed to treat mental health conditions such as anxiety or depression can also contribute to fertility concerns. Side effects of these medications can decrease your desire for sex or cause erectile dysfunction. Try not to feel embarrassed about discussing these issues with your fertility specialist because there are medications that can help.
If you’re concerned your fertility is impacted and you’re trying to get pregnant, make an appointment with one of our CCRM Fertility specialists to undergo a semen analysis.