What Causes Male Infertility?

Male infertility. Two words that can feel like a punch right in the—well, you know. But hold on. Before you start thinking about the worst-case-scenarios here, let’s talk reality. 

A male infertility diagnosis doesn’t mean your dreams of making a baby are over. There are a host of options out there; sometimes even simple ones like making a few lifestyle changes can make a big difference for some couples. So let’s dig in, shall we? 

What does male infertility mean, anyway? 

The phrase, “male infertility” sounds like it would be pretty self explanatory, right? He’s male, and he has infertility issues. But what male infertility really comes down to is sperm. Does he have any? Is it healthy? Can it even get out of his testicles and down through the penis for conception during heterosexual sex? 

Usually, the man’s portion of baby-making is pretty quick. Their sperm needs to somehow make it to a woman’s egg at the time of ovulation, and the two have to combine. From there, the woman’s body takes over and does all the rest of the work. 

If there’s something going on with a man’s sperm, however, conception won’t happen the old-fashioned way. At least not without a little help. 

It happens to a lot of guys

Sure, that’s what they all say, right? In this case, it’s true. The National Institutes of Health estimate that:

• A third of all fertility troubles come down to a man’s reproductive issues 
• A third are a combination of what’s going on downstairs for both the male and female partners in a heterosexual relationship
• The final third is due to a woman’s reproductive issues 

To put things in perspective, if 1 in 8 couples struggle with fertility issues at some point, it actually is true—male-factor infertility actually does happen to a lot of guys. 

What’s going on: male infertility causes

Every male infertility diagnosis is different. But typically, there are a handful of issues that doctors will look for:

Congenital bilateral absence of vas

• What it is: Yes, it’s a lot of fancy words, but all this really means is a blockage of the vas deferens, says Marc Goldstein, M.D., director of the Center for Male Reproductive Medicine and Surgery at Weill Cornell Medicine/New York Presbyterian Hospital. That’s the tube that connects the testes to the urethra. Typically genetic, this condition means the sperm can’t travel from the testicles out the penis. 
• How it’s treated: Believe it or not, this kind of diagnosis is a good one, Dr. Goldstein says, as it can easily be treated surgically. A urologist can collect the sperm directly from the testes then send it to the lab where an embryologist will combine it with a woman’s egg (or eggs), retrieved during IVF treatment, in a process known as intracytoplasmic sperm injection (ICSI for short). Next, a reproductive endocrinologist will transfer the resulting embryo in the woman’s uterus. 

Varicoceles 

• What it Is: You’ve heard of varicose veins? That’s exactly what varicoceles are, Dr. Goldstein says. Only instead of appearing on the legs, where most folks think of them, these varicose veins pop up in the scrotum, affecting sperm production and creating one of the most common male fertility issues. 
• How it’s treated: These bulging veins are typically tied or cut by a doctor. For some men, that can be enough to allow for traditional conception to occur, although studies show it’s not a cure-all for all men. 

Poor sperm morphology

• What it is: A sperm morphology diagnosis basically means there’s something affecting the shape of the sperm that prevents it from fertilizing the egg. 
• How it’s treated: According to Dr. Goldstein, many cases of morphology can be addressed with ICSI or a version of the process known as PICSI, which stands for psychological intracytoplasmic sperm injection. With ICSI, the embryologist still uses collected sperm to fertilize the eggs, but they’ll examine the individual sperm to ensure they’re picking the healthiest of the bunch. The best-looking sperm will be used to fertilize eggs which can then be transferred to the uterus by a reproductive endocrinologist for IVF. 

Low sperm count

• What it Is: Sometimes called oligospermia, a low sperm count is exactly what it sounds like, says Jamin Brahmbhatt, M.D., a urologist at Orlando Health and co-founder of Drive 4 Men’s Health. There’s not a whole lot being produced, which means there are fewer sperm coming out at ejaculation. 
• How it’s treated:  A low sperm count can be caused by a number of issues, from a hormonal imbalance due to usage of steroids to genetic conditions, so treatment will vary. Sometimes it will require lab analysis of sperm, but sometimes lifestyle changes such as stopping testosterone treatments or cutting back on alcohol can do the trick. 

Low sperm motility

• What it is: Motility is just another word for movement, and that’s exactly what doctors are looking for when they’re checking a man’s sperm motility. “If the sperm can’t move then they can’t make it towards the egg,” Dr. Brahmbhatt points out. When there’s low sperm motility, few sperm are able to move or “swim” through the cervix and into the uterus, which is what they need to do to fertilize an egg. 
• How it’s treated: Lifestyle changes may be useful in improving sperm motility, and there are medications that can improve sperm quality, Dr. Brahmbhatt says. If neither of those are successful, typically more assisted technologies such as intrauterine insemination (IUI)—in which a reproductive endocrinologist will deliver the male partner’s sperm directly into the uterus—or IVF might be in order. 

How do I know if I’ve got male infertility?

Ah, right, the question of the hour. Women typically have a relationship with their OBGYN and a place to turn to start getting answers about fertility. 

But men will need to speak to a urologist, preferably a urologist with an expertise in reproductive issues, Dr. Goldstein says. Your urologist will perform a physical examination, run blood tests to check hormone levels, take semen samples for lab analysis and likely perform an ultrasound of the scrotum to nail down just what’s going on down there. 

Do at-home sperm tests actually work?

There are now at-home sperm tests that provide clinical-grade, full sperm analysis. These sperm tests can look at:

• Motility: Sperm that move naturally and efficiently have the best chance of reaching the ovum for fertilization.
• Volume: Semen plays a crucial role in carrying sperm through the reproductive tract. Producing the right amount means giving sperm the best chance at reaching the ovum for fertilization.
• Concentration: Sperm concentration helps contextualize the relationship between your unique volume and count. The right ratio can be as important an indicator of fertility as a high sperm count.
• Morphology: A sperm’s shape affects its ability to both reach and fertilize an egg—this metric helps you understand what percentage of your sperm have a natural shape and what abnormalities there might be.
• Count: Not only does a healthy sperm count improve your chances of conception, it’s also a great indicator of your overall health.

Bottom line

Male infertility is fairly common, but many of the causes have treatment options that can make conception a real possibility. So don’t be afraid to make that urologist appointment. The sooner you do, the sooner you’ll get some answers.