Male infertility

Published by Bupa's Health Information Team, May 2010.

This factsheet is for men who are having trouble conceiving a child with their partner, or anyone who would like information about male infertility.

Infertility is when a couple aren't able to conceive after two years of having unprotected sex. There are a number of things that can affect fertility, although often no cause can be found. This factsheet only considers infertility in men - for information about infertility in women, please see Related topics.

About male infertility

It's thought that one in seven couples in the UK has trouble conceiving. However, it's important to remember that over eight out of 10 couples will conceive within one year of having regular, unprotected sex, and more than nine out of 10 couples will do so within two years.

Infertility has been defined as not getting pregnant within two years of having frequent, unprotected sex. You may have primary infertility - this means you and your partner have never previously conceived a pregnancy together - or secondary, which is when you have.

It's thought that in about four out of 10 couples who have fertility problems, both partners have a condition that affects their ability to have a baby.

Symptoms of male infertility

There aren't any specific symptoms of infertility, but if the problem is caused by a particular medical condition, you may have symptoms as a result of that.

Causes of male infertility

It may not be possible to find a cause for your infertility - this is true for about a third of couples who have problems conceiving.

Sperm disorders

The most common reason for male infertility is a problem with your sperm. This is the cause for three-quarters of men who have fertility difficulties. 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 features occur together.

About 10 to 15 men in every 100 who have problems with fertility have no sperm at all in their semen (azoospermia). There are many reasons why this may be, but the most common is a condition called obstructive azoospermia. This is when you don't have any sperm in your semen because there is a blockage in both of your seminal ducts (the tubes that carry sperm from your testicles to your penis). The blockage may be in the epididymis, vas deferens or ejaculatory duct. The obstruction may be:

• congenital - this means you were born with it, and often it isn't possible to find a cause
• acquired - meaning that you developed the condition as a result of an infection or surgery in the area

Hypogonadism

Your fertility problems may be a result of a condition known as hypogonadism - again, this may be congenital or acquired. If you have hypogonadism, it means that you don't produce enough or any of the hormone testosterone. Congenital causes include being born with one or no testicles, or conditions that affect your hypothalamus and pituitary gland. These conditions are often the result of a genetic problem. Acquired hypogonadism may occur after an illness or accident, or as a result of treatment with certain medicines.

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

Ejaculation disorders

It's rare, but your fertility problems may be caused by a problem with ejaculation. Some of these are explained here.

• Anejaculation is when you don't produce any semen.
• If you have anorgasmia, it means you don't reach orgasm and ejaculation doesn't occur.
• It may be that you need more stimulation than usual to ejaculate - this is called delayed ejaculation.
• Retrograde ejaculation means the semen you produce moves backwards into your bladder instead of being ejaculated outside your body at orgasm.

Other causes

A number of other things can affect your fertility, including:

• smoking, also if your mother smoked during pregnancy
• drinking alcohol excessively
• taking illegal drugs such as cannabis and cocaine
• using anabolic steroids
• chemotherapy or radiotherapy
• being overweight or obese
• the temperature of your scrotum being too high - this may be a result of being exposed to heat as part of your job, or wearing underwear that is too tight
• certain jobs - for example if you're exposed to some chemicals found in pesticides or solvents
• some medicines, such as sulfasalazine or cimetidine
• stress

It's not known whether a man's fertility declines as he gets older.

Diagnosis of male infertility

See your GP if you're concerned about your fertility. If possible, it's a good idea for you and your partner to go together. Your GP is likely to ask you for how long you have been trying to have a baby and whether you have had any problems having sex. He or she may ask you about your lifestyle and medical history including whether:

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

Your GP may also need to examine you.

If you have not already been doing so, your GP is likely to recommend that you have unprotected sex two to three times a week for a year before carrying out any tests. After this time, or sooner if you or your partner have a condition that means you're less likely to conceive, there are a number of tests that he or she may do.

Your GP may suggest a test to see if you have been infected with chlamydia. He or she is also likely to ask you to provide a sample of semen so it can 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 abnormality, you will probably 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 doctor may refer you to a fertility specialist for further tests to see what is causing this.

Treatment for male infertility

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

Self-help

Having sex two to three times a week is thought to maximise the chance of your partner becoming pregnant. Your GP may also suggest making certain lifestyle changes, for example, trying to give up if you smoke and not drinking more than three to four units of alcohol a day. You may also be advised to lose excess weight.

Medicines

Depending on the cause of your fertility problems, you may be prescribed medicines to see if they offer any improvement. If you have hypogonadism, it's possible that having gonadotrophin injections will help - these aim to stimulate the production of testosterone. Medicines that affect your bladder or nervous system may help if you have retrograde ejaculation. However, these medicines can have side-effects such as dizziness and feeling sick.

Medicines such as sildenafil may be helpful if you have trouble getting an erection.

Non-surgical treatments

If an ejaculatory disorder is causing your fertility problems, it's possible that stimulating certain nerves can be helpful. Penile electrovibration stimulation affects your spinal cord causing ejaculation and transrectal electroejaculation directly stimulates the nerves that cause you to ejaculate. These procedures involve using a probe that is placed on the penis or inserted into your rectum (back passage). Electrodes inside this stimulate your nerves bringing about ejaculation.

Surgery

If tests show that you have obstructive azoospermia, you may be able to have surgery to remove the blockage. This is often successful at improving fertility.

Assisted conception

There are several techniques that can be used to help you conceive. These aim to bring a sperm and an egg close together. The three main methods are:

• intra-uterine insemination
• in vitro fertilisation
• intracytoplasmic sperm injection

For more information about these procedures, please see Related topics.

Living with male infertility

If you and your partner are having trouble getting pregnant, it can have psychological and emotional effects. Feeling stressed, whether it's caused by your problems conceiving, work or something else, may affect your relationship with your partner. This in turn may have an impact on your libido and how often you have sex, leading to further fertility problems.

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, you may find it helps to talk to someone who isn't closely involved with your situation. Your doctor or clinic can give you details of a specialist fertility counsellor.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.