Male infertility: the most common causes and issues

Until fairly recently, historically speaking, problems with fertility were generally assumed to originate with the female partner, and early infertility treatments almost always revolved around the woman. These days, we know that male factor infertilityis an issue for up to a third of the couples who struggle to conceive. Many of today’s modern assisted reproductive technologies (ART) can be used to help couples overcome these challenges. 

What are the common causes of male infertility?  

The root cause of a man’s infertility may not be easy to establish. For up to 50% of men diagnosed with male factor infertility, the specific cause remains unknown. Generally, male fertility problems have to do with the quantity or quality of the sperm, though there can also be issues with ejaculation. While the reasons for these problems are often unclear, most of the treatment options remain the same whatever the underlying cause may be. Some of the more common causes include: 

  • Pre-existing genetic conditions 
  • Hormone disorders 
  • Injury to the groin area 
  • Previous surgeries, such as hernia repair or vasectomy 
  • Previous infections, especially STDs, urinary tract infections or a severe mumps infection after puberty. 
  • Exposure to poisonous chemicals or radiation (most common in cancer survivors.) 

There are also certain lifestyle choices which may impact a man’s fertility, such as wearing tight or restrictive underwear or using tobacco, alcohol, or other drugs.  

How is male infertility diagnosed?  

The diagnostic process for men begins with a thorough physical examination, patient interview, and a medical history, all of which may provide insight into contributing factors. The next step is usually a sperm analysis, where a sperm sample is tested in the lab. The lab will perform a sperm count, check the health, shape, and movement of the sperm, and can help to determine the best course of action.  

What are the most common infertility issues faced by men?  

As mentioned, male infertility usually manifests as issues with the sperm or with the process of ejaculation. These issues can take many forms, but the most common problems seen by fertility specialists include: 

  • Azoospermia: This condition is defined as the complete absence of sperm in the semen/ejaculate. Azoospermia affects around 5% of men who suffer from infertility. It may be that the body is not producing any sperm, but more often it is a result of a blockage or obstruction in the ejaculatory ducts or vas deferens. This can prevent any sperm from leaving the testicles and reaching the ejaculate.  
  • Oligospermia: Your doctor may refer to this as a “low sperm count.” Oligospermia means that there are very few sperm cells in the ejaculate. Once again, this could be caused by low sperm production or by a partial ejaculatory ducts or vas deferens obstruction.  
  • Congenital absence of the vas deferens: In some cases, the tubes which transport sperm to the penis in the event of ejaculation do not develop before birth.  A patient who has this condition may actually be producing viable sperm in the testes. However, without a way to travel to the ejaculate, pregnancy becomes impossible. 
  • Ejaculatory duct obstruction (EDO) is a blockage in a man’s ejaculatory ducts may be caused by an injury or infection, or it may be a congenital issue which has been present since birth.  
  • Varicocele: Some men develop enlarged varicose veins in the scrotum. This can affect the reproductive function in several ways, any of which may impact sperm production, quality, and transport.  
  • Poor sperm motility or morphology: Sometimes a man is producing a good quantity of sperm, but there are issues with how the sperm are shaped (morphology) or how they move (motility) These problems can mean that the sperm has a hard time reaching or penetrating the egg. 
  • Previous vasectomy: This is a straightforward cause of infertility, where a man who underwent a vasectomy at an earlier point in his life now wishes to conceive. 
  • Premature ejaculation: If a man consistently ejaculates before vaginal penetration (which can be caused by prostate health issues, mental health issues, and certain medications) the chances of a sperm meeting an egg are very low. 
  • Erectile dysfunction: Consistent trouble achieving or maintaining an erection (often due to medical issues) can make conceiving naturally extremely difficult or even impossible.  

Which fertility treatments can help with male factor infertility?  

There are a number of ways that a fertility clinic can treat male infertility, depending on the source of the problem. If there is a physical issue such as a previous vasectomy, a blockage or a varicocele, surgical solutions may be an answer. 

  • Vasectomy reversal: Depending on the technique used when the original vasectomy was performed, a surgeon can often reconnect the tubes (vans). The reversal surgery is generally an outpatient procedure performed under spinal or general anesthesia. When the surgery is successful and was performed within 10 years of the vasectomy, pregnancy rates are higher  than 50%. Pregnancy is most likely to occur in the first 3 years after the reversal.
  • Ejaculatory duct resection: If a man’s ducts are blocked, they can sometimes be cleared with a minor surgery which takes about an hour. This is a day procedure performed under local or general anesthesia.
  • Varicocele repair: Repairing varicoceles in the scrotum may provide a better environment for sperm, which could help to improve sperm count, motility and mobility. The surgical repair is a minor outpatient procedure. Its effectiveness has not been proven conclusively.

Outside of surgical treatments, In Vitro Fertilization (IVF) can often be extremely effective in cases of male infertility, either used alone or together with supplemental ART treatments.

  • Intracytoplasmic sperm injection (ICSI): ICSI is a procedure which assists in the fertilization of an egg in IVF.  individual high-quality sperm cells are injected right into individual mature eggs. This can help in many cases where there may be a very limited number of healthy sperm cells with which to work. In severe cases of male infertility, ICSI can be an extremely effective treatment.
  • Sperm retrieval:  If a patient appears to be producing no sperm in his ejaculate, has an exceptionally low sperm count, or cannot ejaculate at all, a doctor may be able to retrieve sperm from inside his body, using one of three techniques:
    • percutaneous epididymal sperm aspiration (PESA)
    • testicular sperm aspiration (TESA)
    • testicular sperm extraction (TESE)

For many couples struggling to conceive, seeking help can feel both hopeful and overwhelming. Making an appointment with a fertility clinic to begin exploring your options is an empowering move. It’s a chance to start finding some answers to the questions that have been haunting you. Whatever the cause of a couple’s infertility issues, the road to pregnancy begins with a good diagnosis for one or both partners. 


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