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Male infertility

Although it can take a while, more than eight in 10 couples will get pregnant within one year of having regular, unprotected sex. The majority of other couples will do so within two years. But for one in seven couples in the UK this doesn’t happen.

Our information here is about infertility in men – to read about infertility in women, please see our Related information.

Infertility is defined as not getting pregnant within a year of having regular sex without using contraception. It can be because there is something affecting you or your partner. And in about four in 10 couples with fertility problems, both partners have a condition that affects their ability to have a baby.

There are two types of infertility.

  • Primary infertility. This means you and your partner have never previously conceived (got pregnant) together.
  • Secondary infertility. This is when you and your partner have conceived before but are now having difficulty.
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Details

  • Symptoms Symptoms of male infertility

    There aren’t any specific symptoms of infertility except being unable to get your partner pregnant. However, if the problem is caused by a particular health condition, that may cause symptoms. These could include:

    • pain and swelling in your testicles (if you have an infection)
    • blood in your semen
    • pain after you ejaculate
    • not being able to get or keep an erection
    • not being able to ejaculate when you have sex
    • difficulty emptying your bladder

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  • Diagnosis Diagnosis of male infertility

    If you and your partner have been trying to get pregnant for at least a year and you’re worried about your fertility, see your GP. It’s a good idea for you and your partner to go together.

    Your GP will ask you how long you have been trying to have a baby and whether you have had any problems having sex. They may ask you about your lifestyle and medical history including if you:

    • have had children with a previous partner
    • have ever had any sexually transmitted infections (STIs), serious long-term diseases or other conditions that can affect fertility
    • are taking any medicines

    Your GP may need to examine you and do some tests. For example, they may suggest a test to check if you have been infected with chlamydia. If your doctor thinks you may have retrograde ejaculation, they will check a sample of your urine to see if it contains any sperm.

    Your GP may also ask you to provide a sample of semen. It will be tested for a number of things, including how many sperm it contains and how fast they are able to move. If this shows any problems, you will need to have the test repeated after three months. This may be done sooner depending on the findings of the first test. If the second test confirms that there is a problem with your sperm, your GP may refer you to a fertility specialist.

    Your fertility specialist will examine you if you have a problem with your sperm. You may also be recommended further tests, which could include hormone checks, chromosome tests and screening for cystic fibrosis. Your fertility specialist may recommend a test to check for any damage to the DNA of your sperm.

  • Treatment Treatment for male infertility

    Your treatment will depend on what is causing your fertility problems.

    Self-help

    Having sex every two to three days will maximise your chance of your partner getting pregnant.

    Your doctor may also suggest you make certain changes to your lifestyle. These may include stopping smoking and not drinking more than three to four units of alcohol a day. They may also advise you to lose any excess weight. A healthy, balanced diet is important too. Antioxidants, such as vitamin C and vitamin E, as well as minerals, such as selenium and zinc, are important for sperm health. These nutrients can be found in a variety of foods including nuts, oily fish, green vegetables and tomatoes.

    Medicines

    Depending on the cause of your fertility problems, your doctor may prescribe you medicines to try to improve your chance of conceiving.

    If you have hypogonadism, it’s possible that gonadotrophin injections will help. These aim to stimulate your body to produce testosterone. Medicines that affect your bladder or nervous system may help if you have retrograde ejaculation. However, these medicines can have a number of side-effects, such as making you feel sick. Medicines such as sildenafil (Viagra) may be helpful if you have trouble getting an erection.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.

    Non-surgical treatments

    If your fertility problems are caused by a problem with ejaculation, it’s possible that stimulating certain nerves using electrodes may help. Penile electrovibration stimulation and transrectal electroejaculation stimulate nerves involved with ejaculation. These procedures use electrodes on a probe that is placed on your penis or inside your rectum (back passage).

    Surgery

    If tests show that you have obstructive azoospermia, you may be able to have surgery to remove the blockage, which may improve your fertility.

    If you have had a vasectomy, it may be possible to have this reversed. Ask your doctor if this is an option for you.

    Assisted conception

    There are several methods of assisted conception (also called assisted reproduction) that may be available to you, depending on what is causing your infertility. Some of these involve sperm or an egg donated from another person if you or your partner has a problem producing sperm or eggs.

    The main methods are described here.

    • Intra-uterine insemination (IUI). Sperm are placed into your partner’s womb around the time of ovulation (when an egg is released from the ovary).
    • In vitro fertilisation (IVF). An egg is fertilised with sperm in a laboratory and transferred into your partner’s womb.
    • Intracytoplasmic sperm injection (ICSI). Sperm is injected into an egg in a laboratory and then transferred into your partner’s womb.

    For more information about these procedures, see Related information.

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  • Causes Causes of male infertility

    There are various reasons why you may have trouble getting your partner pregnant, although in about a quarter of couples, doctors can’t find any cause.

    Sperm disorders

    The most common reason for male infertility is a problem with your sperm. It may be that:

    • you don't have enough sperm in your semen
    • your sperm don't move as fast as they need to
    • your sperm are the wrong shape

    Usually these three things occur together.

    Some men who have problems with fertility have no sperm at all in their semen. This is called azoospermia. There are many reasons why this may be but the most common is a condition called obstructive azoospermia. This is when the tubes (called seminal ducts) that carry sperm from your testicles to your penis are blocked. The obstruction may be:

    • congenital – this means you were born with it
    • acquired – this means you developed the condition as a result of an infection or surgery in the area, such as a vasectomy

    Hypogonadism

    It’s possible your fertility problems may be a result of a condition known as hypogonadism. This means you don’t produce enough, or any, of the hormone testosterone and this can affect your production of sperm.

    Hypogonadism may be congenital or acquired. Congenital causes include being born with one or no testicles, or conditions that affect your hypothalamus and pituitary gland, which are important for hormone production. These conditions are often the result of a genetic problem. Acquired hypogonadism may happen after an illness or accident, or as a result of taking certain medicines. Medicines that can cause hypogonadism include spironolactone, which is a water tablet (diuretic), and cyproterone, which is used to treat prostate cancer.

    Testosterone has many functions in your body, but it’s essential for the healthy development of your genital organs and production of sperm. You also need testosterone to get an erection and to maintain your sex drive (libido).

    Ejaculation disorders

    For some men, fertility problems are caused by a problem with ejaculation. Some of these are explained here.

    • Anejaculation is when you don’t ejaculate any semen.
    • If you have anorgasmia, this means you don’t reach an orgasm and ejaculate.
    • Delayed ejaculation is when you need more stimulation than usual to ejaculate.
    • Retrograde ejaculation means the semen you produce moves backwards into your bladder instead of being ejaculated outside your body when you orgasm.

    These problems can be caused by a number of different things, such as diabetes, an operation on your prostate or psychological issues.

    Other factors that affect fertility

    There are a number of other factors that can affect your fertility, which include:

    • smoking and drinking alcohol excessively – these may affect the quality of your sperm
    • taking illegal drugs, such as cannabis and cocaine
    • using anabolic steroids
    • chemotherapy or radiotherapy
    • being overweight or obese
    • having testicular atrophy, which is when your testicles shrink
    • the temperature of your scrotum being too high – various things could raise the temperature, such as resting a laptop on your lap
    • certain jobs – for example, if you’re exposed to some chemicals found in pesticides
    • some medicines, such as sulfasalazine (a medicine used to treat rheumatoid arthritis and inflammatory bowel disease)
    • stress

    It’s worth remembering too that a man’s fertility declines as he gets older although not to the same extent as a woman’s.

  • Living with male infertility Living with male infertility

    If you and your partner are having trouble getting pregnant, it can be upsetting and stressful. Feeling stressed, whether it’s caused by your problems getting pregnant, work or something else, may affect your relationship with your partner. This in turn can have an impact on your sex drive and how often you have sex, which can lead to further difficulties conceiving.

    You may find it helps to talk to other people. There are support groups where you can meet couples who are also having treatment for infertility. Alternatively, your doctor or clinic can give you details of a specialist fertility counsellor.

  • FAQs FAQs

    Can complementary therapy help male infertility?

    Answer

    There is no evidence to suggest that any complementary therapy can help infertility.

    Explanation

    At the moment, no good quality research has shown that complementary therapy is helpful in treating infertility. Further studies are needed before doctors can recommend any particular therapy.

    A small amount of research has been done to look at how effective certain herbal remedies are in improving male erectile dysfunction. Two substances you may have heard of are yohimbine – a substance found in the bark of an African tree – Korean red ginseng. However, nothing definite has been found that shows they are effective and it’s also important to remember that natural doesn’t mean harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Speak to your pharmacist or GP before you take any.

    Is it true that having mumps as a child can affect your fertility?

    Answer

    No, if you have mumps as a child, it won’t affect your fertility. If you get mumps as a teenager or adult and it causes inflammation of your testicles, you may have a greater risk of fertility problems.

    Explanation

    If you get mumps as an adult, it’s possible that this will lead to inflammation of one or both of your testicles, which is called orchitis. You may also get inflammation in your epididymis, which is called epididymo-orchitis. Up to one in four men who have mumps after puberty will develop this condition. Up to a third of these men will have swelling on both sides.

    It’s possible that epididymo-orchitis can cause problems with your production of sperm. If you’re concerned about your fertility following mumps infection, see your GP who may suggest a test to check that your sperm is healthy.

    Will chemotherapy affect my fertility?

    Answer

    It's possible that some chemotherapy medicines will reduce your fertility. However, this may only be temporary.

    Explanation

    Not all chemotherapy medicines will reduce your fertility but some may damage your sperm or reduce how many you produce. Chemotherapy may also reduce your ability to get an erection because it can affect the nerves that supply this area. These problems will probably go away once you finish having chemotherapy but it may take several months or years to return to normal. It’s important to use contraception while you’re having chemotherapy and for at least a year afterwards. This is because it may harm your baby if you and your partner get pregnant.

    Although your fertility may be only temporarily affected by chemotherapy medicines, it’s also possible that you won’t be able to have children in the future. It’s important to speak to your doctor before you have any treatment that may affect your fertility. They will be able to give you advice about storing your sperm before you start treatment.

  • Resources Resources

    Further information

    Sources

    • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • Gurunath S, Pandian Z, Anderson RA. Defining infertility – a systematic review of prevalence studies. Hum Reprod 2011; 17(5):575–88. doi:10.1093/humupd/dmr015
    • Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
    • Fertility basics. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 1 June 2012
    • Female infertility. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 11 November 2010
    • Infertility – male. PatientPlus. www.patient.co.uk/patientplus, published 9 April 2013
    • 2010 United Kingdom national guideline for the management of epididymo-orchitis. British Association for Sexual Health and HIV. www.bashh.org, published 2010
    • Male infertility. Medscape. www.emedicine.medscape.com, published 22 April 2014
    • Guidelines on male infertility. European Association of Urology. www.uroweb.org, published March 2013
    • Hypogonadism. Medscape. www.emedicine.medscape.com, published 9 June 2014
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 16 July 2014
    • Sperm disorders. The Merck Manuals. www.merckmanuals.com, published January 2013
    • Mumps. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2013
    • Male infertility: management. Urology Care Foundation. www.urologyhealth.org, published April 2013
    • Avendaño C, Mata A, Sanchez Sarmiento CA. Use of laptop computers connected to internet through wifi decreases human sperm motility and increases sperm DNA fragmentation. Fertil Steril 2012; 97(1):39–45. doi:10.1016/j.fertnstert.2011.10.012
    • Balasch J, Gratacós E. Delayed childbearing: effects on fertility and the outcome of pregnancy. Fetal Diagn Ther 2011; 29:263–73. doi:10.1159/000323142
    • What are nutrients? British Nutrition Foundation. www.nutrition.org.uk, published 4 January 2013
    • Showell MG, Brown J, Yazdani A, et al. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2014, Issue 12. doi: 10.1002/14651858.CD007411.pub3
    • Infertility treatments. PatientPlus. www.patient.co.uk/patientplus.asp, published 9 April 2013
    • Jang D-J, Lee MS, Shin B-C, et al. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol 2008; 66(4):444–50. doi:10.1111/j.1365-2125.2008.03236.x
    • The management of erectile dysfunction: an update. American Urological Association. www.auanet.org, published June 2007
    • Erectile dysfunction. PatientPlus. www.patient.co.uk/patientplus, accessed 12 April 2013
    • The effects of cancer treatment on reproductive functions: guidance on management. Report of a Working Party Group. Royal College of Physicians, The Royal College of Radiologists, Royal College of Obstetricians and Gynaecologists., published November 2007 www.rcr.ac.uk
    • Epididymo-orchitis. PatientPlus. www.patient.co.uk/patientplus, published 4 November 2013
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