Male factor infertility: What you need to know

Lots of us assume that starting a family is a straightforward process, but for many couples, this isn’t the case. 

If you and your partner are struggling to conceive, then it’s important to remember that you’re not alone. Infertility, or not being able to conceive after one year of regular unprotected sex, is really common; in fact, it affects one in five couples.

Not only is infertility common, but nearly 30% of infertility cases in heterosexual couples are related to male factor infertility issues alone, while 30% to 40% of infertility cases are due to a combination of female and male factors. So why is male infertility rarely talked about?

“Traditionally, fertility treatment and evaluation have been very focused on women in the past,” says Dr. Tolulope Bakare, urologist and assistant professor, Texas, US. And we can see that from the stats: Just 41% of obstetricians and gynecologists would consider a urological evaluation of the male partner if a couple was struggling to conceive, according to RESOLVE: The National Infertility Association. 

That means lots of couples are potentially missing out on getting the answers they need along with the fertility treatment they deserve. Dr. Bakare says, “It’s really essential that men are now starting to be recognized as a vital part of the evaluation and workup of infertility in couples.”

Below, Dr. Bakare answers the most common questions about male factor infertility, including what it is, the causes, and the support your health care provider may offer to you if you’re trying to conceive. 

What is male infertility?

Simply put, male factor infertility describes the reasons why someone with a penis may struggle to conceive after one year of regular, unprotected vaginal sex (or six months if their female partner is 35 or older).

As we know, healthy sperm is needed to fertilize an egg, so male infertility is having an issue in the reproductive system that prevents that person from being able to conceive.

According to Yale Medicine Urology, an estimated 15% of couples in the United States have trouble conceiving. Hearing the term “infertility” can be really daunting, but your medical professional should be able to talk you through your testing options and may be able to give you a better idea as to why you might be struggling to conceive.

What causes male infertility?

The causes of male infertility can generally be split into obstructive causes (anything that obstructs the sperm from leaving the penis) and nonobstructive causes (problems with sperm production or the sperm’s functionality). The good news is that in many cases, causes can be identified and male infertility can be effectively treated. 

Common causes of male infertility include: 

• Hormonal disorders, which can impact the pituitary gland in the brain. Any disorders that impair hormone production in this part of your brain can lead to low or no sperm production and low blood testosterone levels.
• Ejaculation disorders, such as retrograde ejaculation (semen is ejaculated backward into the bladder), premature ejaculation, and delayed ejaculation
• Erectile dysfunction (being unable to keep an erection)
• Structural problems like scar tissue, inflammation, and genetic defects could stop the flow of semen or sperm.
• Genetic abnormalities, such as Klinefelter syndrome (when you’re born with an extra X chromosome) and Robertsonian translocation (where one chromosome attaches to another)
• Medical conditions like varicocele, which are dilated veins in the scrotum that may affect semen quality, including sperm count or sperm mobility. If sperm mobility is affected, the sperm will be too slow to reach and fertilize an egg.
• Certain medications can cause low sperm count and infertility. Medications that are prescribed to treat high blood pressure, chest pain, and indigestion may also cause infertility. Chemotherapy can also damage the sperm in both adult males and adolescents (or the sperm-forming cells in young boys).

Remember: Lots of the causes of male factor infertility are treatable, and many couples experiencing them go on to successfully conceive with a little medical help. One of those couples was Sam and Rachel* from London, who had fertility tests at a private clinic after trying for a baby for six months. 

“I was surprised and disappointed when I found out I had male factor infertility, especially as I’d previously fathered a child,” Sam says. “But the fertility doctor was optimistic. She explained that we would need intracytoplasmic sperm injection [when sperm is physically injected into an egg in a lab] to conceive, so that’s what we did. The process wasn’t easy — Rachel had to inject fertility medications and have an egg collection — but we’re now expecting a baby boy. I’d tell anyone in the same position to speak to their doctor.”

What are the signs of male infertility?

When you’re trying to conceive, infertility itself can be the biggest sign that you may need to speak to a specialist about fertility testing. However, there are other less-obvious signs to watch out for, including: 

• Issues with sexual function, such as changes in sexual desire or trouble maintaining an erection
• Pain or swelling in the testicles
• Struggling to ejaculate
• Unexpected breast growth (gynecomastia)
• Reduced facial or body hair

Listening to your body and keeping an eye out for any changes may help you when talking about possible fertility problems with an expert. When you’re trying for a baby, conception can become all consuming, but it’s important to remember that you’re not alone and any fertility struggles you’re facing aren’t your fault. 

Dr. Bakare highlights that male infertility may also be linked to another underlying medical problem. “In some cases, there are other medical conditions that are causing infertility in men, and they may have no idea,” she says. “I recently saw a patient in my clinic that came to me for infertility. While taking his history, he mentioned that he’d had a lot of bronchitis since he was a child, and that prompted me to do genetic testing on him for cystic fibrosis. That was the first time he’s ever been diagnosed with cystic fibrosis in his life.” 

She adds that advocating for yourself or your partner is vital because you both need answers. Fertility testing can be really daunting and emotional, so it’s crucial that you feel listened to and supported by your medical professional.

How is male factor infertility diagnosed?

Once you’ve reached out to your health care provider and expressed concerns about your fertility, they’ll likely book you in for an initial assessment. This starts with taking a medical history and a physical examination. During this time, your medical professional will ask about any prior surgeries you may have had, current medications you’re taking, and any family history of infertility or birth defects. They may also order one or more lab tests. 

Initial lab tests may include a semen analysis, which looks at the health of your sperm, including your sperm count, the size and shape of your sperm, their ability to move, and the volume of your sample. Hormone tests are done in the form of a blood test. They measure your follicle-stimulating hormone, luteinizing hormone, and testosterone — all crucial for producing healthy sperm. 

If your health care provider is unable to diagnose you or your partner following an initial evaluation, further testing may be required. 

Additional tests could include: 

• A scrotal ultrasound: This could help your health care provider detect varicoceles (varicose veins) or duct obstructions in the scrotum. They may also order a transrectal ultrasound to check your prostate and look for blockages.
• Genetic tests: These look for any inherited abnormalities that could impact infertility.
• Specialized sperm function tests: These can check how well your sperm performs throughout the different stages of fertilization. 

How can male infertility be cured?

There’s no single approach to treating male factor infertility, but the good news is that there are lots of options available. Your health care provider may recommend a combination of medical and lifestyle treatments, depending on what the root causes of infertility are.  

If you’re unsure about any of the treatments that your health care provider has suggested to you, then don’t be afraid to ask questions. It’s really important to understand how the treatment will fit into your life and your plans to have a family. 

What are the treatment options for male factor infertility? 

From intracytoplasmic sperm injection and in vitro fertilization to surgery and medication, possible treatment options for male infertility include: 

• Lifestyle changes: Some lifestyle changes have been linked to improved fertility. This could mean eating a healthy diet, maintaining a healthy weight, stopping smoking, drinking less alcohol, and upping your exercise levels.
• Medication: Some male infertility cases can be treated with hormone replacement therapy or medication. Common medications for treating male factor infertility include clomiphene citrate, anastrozole, and human chorionic gonadotropin or menotropin (in the form of injections). You should speak to a medical professional before considering taking any medication for infertility to make sure it’s right for you.
• Surgery: Your health care provider may suggest a vasectomy reversal and sperm retrieval. 
• Assisted reproductive technology (ART) treatments: Some couples may decide to pursue fertility treatment to build their family. This might involve intracytoplasmic sperm injection, when sperm is physically injected into an egg, or in vitro fertilization, when eggs are mixed with sperm in a lab. Additional ART treatments include intrauterine insemination, which may help if you’re having trouble maintaining an erection or have difficulty having sex.

Male factor infertility: The takeaway

Dealing with infertility is difficult both physically and emotionally, but if you work with your partner and a fertility specialist, you can increase your chances of getting pregnant. 

Some signs of male infertility include testicle pain and swelling, along with changes in sexual desire. Changes in your sexual health can be really scary, and if you haven’t been able to conceive within a year, you may be concerned. But rest assured, your health care provider is there to listen and help. They’ll talk through your symptoms, do a physical examination and run some tests, such as semen analyses, and explain the various infertility treatments available, such as intracytoplasmic sperm injection or in vitro fertilization, if necessary.

It’s crucial to remember that you’re not alone. According to the World Health Organization, infertility affects approximately 48 million couples and 186 million individuals globally. You can find help and support via RESOLVE in the United States, HIMfertility in the United Kingdom, and Access Australia.

*Names have been changed.