Male

For the 1 in 8 couples experiencing difficulty getting pregnant, male factor issues are involved in about half the cases.¹

There are many reasons why a man may have fertility problems. Fortunately, once diagnosed, some of these causes may be treatable.

Sperm disorders

A major cause of fertility problems is sperm disorder. Of the millions of sperm normally deposited into the vagina, only a few hundred will get close to the egg and have a chance to fertilize it. Many factors play a role in determining whether or not the sperm will succeed:

• Sperm count (total number of sperm in a sample)²
• Sperm concentration (number of sperm per milliliter of semen)²
• Volume of semen the man produces²
• Sperm motility (number of sperm with the ability to move)²
• Forward progression (quality of movement)²
• Sperm shape²

A deficiency in any of these factors may cause infertility. Although sperm count is important, sperm motility and forward progression appear to be even more crucial in determining the likelihood of whether or not the sperm will succeed in fertilizing the egg. Despite a low sperm count, many men with high-quality sperm may still be fertile.

As a result of these many factors, it is important to perform semen analysis early on in the attempt to determine the reasons for infertility.³ Two to three analyses should be performed over a period of two to six months since sperm quality can change over time.¹ These tests will help give doctors a broader overview of any infertility issues related to the man's sperm.

What causes sperm disorders? A variety of issues including:

• Age. Generally, a man's fertility starts declining at around the age of 35 as the quality of a man's sperm diminishes. In addition, sperm motility can also decline with age.⁴
• Immune disorders. Problems with the immune system can cause a man's body to treat sperm as if it were a foreign matter. As a result, the immune system may produce antibodies to fight and destroy the sperm.⁵
• Cancer treatments. Depending upon the location of the treatment and the drug and dosage used, chemotherapy and radiation may contribute to fertility problems. If you're undergoing treatment for cancer, you can find fertility information and support at Fertile Hope.
• Sexually transmitted diseases (STDs). STDs may damage the parts of the body that transport sperm through the reproductive tract.
• Other factors. Lifestyle and environmental factors may lead to issues with a man's sperm.

For more information about male fertility or to receive a free copy of the In The Know: What No One Tells You About Male Fertility booklet, register now with Fertility LifeLines™. Current members can order a free copy by calling the hotline at 1-866-LETS-TRY (1-866-538-7879). All calls are free and confidential. This 20-page booklet developed by Fertility LifeLines™, Men’s Health Network, and the Society for the Study of Male Reproduction provides an overview of male infertility, including biological and lifestyle factors. It also has tips on dealing with stress, ways to communicate with your partner or spouse, and a checklist of questions to ask your healthcare provider and insurance company.

Anatomical issues

A variety of possible anatomical problems can influence fertility:

• Scrotal varicocele. Varicocele is one of the most commonly identifiable causes of male infertility. Varicocele is a varicose vein around a testicle that may hinder sperm production, movement and shape by raising the testicle's temperature.⁶
  Scrotal varicoceles are found in about 15% of males and in approximately 40% of infertile men, most often on the left side or simultaneously on both sides.³
• Retrograde ejaculation. Retrograde ejaculation involves the ejaculate flowing backward into the bladder instead of leaving the penis.⁷
• Undescended testis. An undescended testicle is one that has failed to complete its passage from within the abdomen to reach its normal position in the scrotum. This condition is present in about 3% of newborns, with fewer than 1% needing treatment. Testicles that don't descend into the scrotum are not likely to function normally. Because they may not make sperm, they can cause fertility difficulties.⁷
• Erectile dysfunction. Erectile dysfunction is the inability to get or maintain an erection. An erection is essential for ejaculation.

When should you see a healthcare provider?

You should see a healthcare provider any time you have concerns about your fertility. Don't wait! You should visit a healthcare provider if any of the following risk factors apply to you:

• History of sexually transmitted disease
• History of pelvic/genital infection
• Previous abdominal surgery
• Reversal of surgical sterilization
• Chronic medical condition (e.g., diabetes and high blood pressure)
• History of chemotherapy or radiation therapy
• Mumps after puberty
• Previous urologic surgery
• Prostate infection
• Family history of cystic fibrosis or other genetic disorders

• 1. American Society for Reproductive Medicine. Infertility: an overview: a guide for patients. Birmingham, Alabama: American Society for Reproductive Medicine; 2003.
• 2. Diagnostic Testing for Male Infertility PDF. American Society for Reproductive Medicine Web site. Available at: http://www.asrm.org/Patients/FactSheets/Testing_Male-Fact.pdf. Accessed December 9, 2008.
• 3. Frequently Asked Questions About Infertility page. American Society for Reproductive Medicine Web site. Available at: http://www.asrm.org/Patients/faqs.html. Accessed December 9, 2008.
• 4. Eskenazi B, Wyrobek AJ, Sloter E, et al. The association of age and semen quality in healthy men. Hum Reprod. 2003;18(2):447-454.
• 5. Quallich S. Examining male infertility. Urol Nurs. 2006;26(4):277-288.
• 6. Varicocele PDF. American Society for Reproductive Medicine Web site. Available at: http://www.asrm.org/Patients/FactSheets/Varicocele.pdf. Accessed December 9, 2008.
• 7. IBID p-4