What Causes Male Infertility? – Symptoms & Treatment

By MD, MSc (andrologist), BSc, PhD (senior embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 02/12/2019

Male sterility has a very important role in the sterile couple, since around 30% of the problems when it comes to getting pregnant correspond to a male factor.

The sterile man usually presents a low seminal quality in most cases, which means that their sperm do not have enough capacity to fertilize the egg and result in a pregnancy.

Depending on the cause of this male infertility, it will be possible to apply a specific treatment that allows these couples to be parents.

The different sections of this article have been assembled into the following table of contents.

Reasons for infertility in males

Male sterility can be caused by a series of factors that can be classified into four groups:

Pre-testicular or endocrine factor
hormone imbalances affecting the development and/or the testicular function.
Testicular factor
when the cause of infertility can be found directly on the testes.
Post-testicular factor
problems with the ejection of sperm.
Sperm abnormalities
issues directly linked to the quality of the sperm produced.

In spite of the wide range of causes leading to male sterility, each one of them affects the quality of the ejaculated sperm to some extent. In order for a semen sample to have the adequate quality, parameters such as sperm concentration, sperm motility, sperm morphology, and sperm vitality should be within the normal values.

In order to diagnose what may be the cause of male sterility, it is necessary to perform some diagnostic tests, among which the spermogram stands out. If you would like more information about this, we recommend that you visit the following article: Male Fertility Testing.

Below, you will learn more about each type of male infertility:

Pre-testicular or endocrine causes

This type of male infertility is caused by problems with the hormonal regulation of the spermatogenesis, in other words, the sperm production.

The hormones secreted by the pituitary gland, LH and FSH, which act on the male reproductive function, may be altered for any of the following reasons:

These alterations can be due to congenital problems or be caused by external factors such as some substances or drugs ( for example, anabolic agents), which can affect the entire hormonal regulation system and cause fertility problems.

You can learn more about this subject reading this post: Pre-testicular causes of male infertility.

Testicular causes

When we say testicular causes of male infertility, we refer to any factor affecting directly the testes. An alteration or defect in these reproductive organs can be congenital or acquired, that is, caused by external agents at any point in the patient’s life:

Congenital anomalies or abnormalities
Caused by genetic diseases, either by chromosomal conditions (i.e. the Klinefelter Syndrome), genetic causes, like the Noonan syndrome, or diseases caused by defects in the genes of the Y chromosome.
Acquired disorders
In this group, we find those problems caused as a side effect or adverse reaction of certain drugs, such as chemotherapy, drug use, radiotherapy, trauma, infections, etc. The best-known pathologies are varicocele, cryptorchidism, orchitis and hydrocele.

If you are interested in more detailed information on this subject, we invite you to continue reading here: Testicular Disorders & Infertility.

Post-testicular causes

The post-testicular causes of male infertility comprise a set of complications derived either from a blockage or an abnormality in the seminal duct.

The seminal ducts are the epididymis, the ductus deferens and the urethra, which must be crossed by the sperm to go out once they have been produced by the testicles.

The causes of this obstruction can be various, such as infections, trauma, antisperm antibodies, hypospadias or cystic fibrosis.

The inability to ejaculate is also considered a post-testicular alteration.

If you are interested in this topic, you can read on in the following article: Post-Testicular Factors of Male Infertility.

Sperm abnormalities

Male infertility due to sperm abnormalities, that is, alterations in the sperm parameters is the leading cause of male infertility. This group includes those alterations in the sperms that affect directly their morphology, motility, vitality, or count.

In order for the sperm quality to be evaluated, a semen analysis is the diagnostic test of choice, which allows the specialist to determine the presence of the following alterations:

Oligospermia or oligozoospermia
low sperm count.
Asthenozoospermia
issues with sperm motility.
Teratospermia or teratozoospermia
large amount of sperms with an abnormal morphology.
Necrospermia or necrozoospermia
large amount of dead sperms in the ejaculate.
Azoospermia
zero sperm count.

You can find in the following post the List of Sperm Disorders that Cause Male Infertility.

Symptoms of infertility

In most cases, the man will not experience any obvious signs of infertility. In almost all cases, the only sign of male infertility is the inability to conceive a child after one year trying to conceive.

On the other hand, if the man has already been diagnosed with another disease such as hypogonadism, he can already suspect that he will have difficulty having children.

Other signs and symptoms commonly associated with male infertility include:

  • Low libido and erection problems.
  • Altered semen with an abnormal color, strong odor, very watery or very thick, etc..
  • Smaller than normal testicles.
  • Changes in voice, hair loss or decreased muscle mass indicate possible hormonal changes.
  • Alterations in the urine or pain when urinating that alerts of a possible infection.
  • Appearance of varicose veins in the testicles.

If these symptoms appear during searching for pregnancy, the man should have a study that includes the necessary tests to confirm whether it is a case of male infertility.

Treatment

To deal with male infertility, it is necessary to know the cause that prevents having a pregnancy in the first place. In some cases, it is possible to recover male fertility after pharmacological treatment or surgery. In the most severe cases, the only option will be assisted reproduction.

Below, you will find some possible treatments for male infertility:

Natural treatment
A healthy lifestyle with a balanced diet combined with vitamin supplements can help improve seminal quality in lighter cases. Above all, antioxidants such as selenium, carnitine and vitamins E, A, C and B12 are very important.
Hormonal drugs
gonadotropins and clomiphene citrate, for example, are given to men with hypogonadotropic hypogonadism.
Surgical intervention
for testicular conditions such as cryptorchidism or varicocele.
Assisted Reproduction
when the previous options cannot be applied or have not been successful. In the face of a severe male factor, the technique that offers the best success rates is ICSI (Intracytoplasmic sperm injection).

We recommend you to visit the following post in order to get more information about this subject: Treatments for Male Infertility.

Do you need donor sperm for your fertility treatment cycle? Then we recommend that you get your Fertility Report now to find the most suitable clinic for you. Our thorough selection criteria when it comes to recommending clinics plus your particular needs equal the best fertility center for you. You will receive in your inbox a detailed report with the clinics that we recommend for your particular treatment, as well as the conditions that they offer for each program.

How common is infertility in men?

According to the US National Institute of Child Health and Human Development (NICHD), one-third of infertility cases are caused by male reproductive problems, one-third by female reproductive issues, and another one-third by both, or by unknown factors. Azoospermia, that is, a complete lack of sperm occurs in about 10% to 15% of infertile men.

The NICHD estimates that the major causes leading to male sterility are problems in the functionality of the testes, followed by hormone imbalances or blockages in the reproductive organs.

In general, global male infertility statistics show that infertility affects 15% of couples, which amounts to 48.5 million couples approximately. Males are found to contribute to 50% of cases overall, and are estimated to be responsible for 20-30% of infertility cases.

Male infertility rates are higher in Africa, Central Europe, and Eastern Europe. As for North America, Australia, and some regions of Central and Eastern Europe, the rate varies from 5-12%. Out of the cases of infertility in the USA, Latin America, and European countries, almost half of them are due to male factor.

It is important to study the male factor

During her speech at the exhibition organized by inviTRA.es in 2013 and dealing with ART, Dr. Ana Mª Segura Paños spoke about the role of andrologists in the diagnosis of male infertility, as well as the solutions these couples have to become parents.

There are two factors involved: the female factor, which is the egg, and the male factor, which is the sperm, I insist, fertility includes two people, it is something that must be shared by both sides.
[…] Reasons for infertility in both partners should be examined, and if a medical solution to the problem can be found, all possibilities should be tried.

FAQs from users

Why has sperm quality experienced such a dramatical decrease amongst males in the past few years?

By Emilio Gómez Sánchez BSc, PhD (senior embryologist).

A number of scientific studies suggest that sperm quality has decreased substantially in the past 50-80 years. For instance, a recent study indicates that, on average, the sperm count per ml is 52%, and the total amount of ejaculate is 59%.

These studies suggest that the decreased is more noticeable in industrialized countries.

Although the causes of this phenomenon are varied, it seems that the main reason can be found in the environment, and are endocrine disruptors. I am talking about chemical substances that simulate the effect of hormones by sending confusing signals to the organism, causing different dysfunctions, including a reduction in the sperm production process.

Endocrine disruptors are commonly found in consumer products, such as plastic, personal hygiene products, cleaning products, air fresheners… Also, many are present in foods.

Some examples of endocrine disruptors are dichlorodiphenyltrichloroethane (DDT), which was prohibited long time ago, bisphenol A, phthalate, styrene, certain solvents, resorcinol, etc.

Can HPV cause infertility in males?

By Zaira Salvador BSc, MSc (embryologist).

Some studies link the infection of semen with HPV to an impairment of sperm parameters, which suggests a potential role in male infertility, particularly in sperm motility. Also, it has been related to an increased risks of miscarriage among couples undergoing IVF, especially when HPV DNA was found in the semen sample of the male partner.

Can Chlamydia cause infertility in males?

By Zaira Salvador BSc, MSc (embryologist).

Yes, recent studies have shown that Chlamydia can harm the quality of the male sperm, as the degree of sperm fragmentation in these men’s sample is almost three times higher than in healthy males. Poor sperm motility, having defective shapes, or a low sperm count are the sperm parameters that could be affected by a Chlamydia infection.

Can infertility in males be cured?

By Zaira Salvador BSc, MSc (embryologist).

As long as male infertility is caused by a factor that can be cured, the answer is yes. However, it should be clear that infertility is not what can be cured, but the cause behind it. Blockages, toxic habits, treatments with reversible effects, etc. can be cured and the man recover his fertility. On the other hand, if the cause is unknown or irreversible (e.g. chemotherapy, congenital diseases…), there exists no cure.

Does testicular trauma affect fertility?

By Zaira Salvador BSc, MSc (embryologist).

Yes, although the long-term effects of testicular trauma on reproductive function remain still unknown. The most common consequence of testicular trauma in male fertility is testicular atrophy, which causes the testes to diminish is size and leads to a loss of function.

Can problems with sperm cause miscarriage?

By Zaira Salvador BSc, MSc (embryologist).

Yes. In cases where the father has a high incidence of abnormal chromosomes in his sperm, the risk of miscarriage is higher. Nevertheless, to date we still do not have any real percentages for how frequently the sperm is a factor leading to recurrent pregnancy loss.

Does sperm quality decrease as a man ages?

By Zaira Salvador BSc, MSc (embryologist).

Yes, the sperm quality of older men is lower than in young males. This decrease in fertility is not so significant as in females, though. From the age of 40 onwards, a man’s fertility starts diminishing. Investigations have shown that the sperm volume and the sperm count diminish as a man ages. The reduction occurs slowly, yet progressively. At the same time, the levels of oxidative stress tend to be higher.

The chances of the sperms developing some kind of genetic abnormality increase as well. However, a man can continue to be fertile, that is, capable of causing pregnancy in a fertile female at the age of 50, 60 or even 70. See also: Andropause or “male menopause”.

Can male infertility be cured with diet?

By Zaira Salvador BSc, MSc (embryologist).

A balanced diet, rich in antioxidants such as vitamin supplements or omega 3, can boost sperm quality in certain cases. However, improvement is not possible in the most severe cases of infertility. In such cases, fertility treatments are the only solution to achieve pregnancy. The following post may be of interest: Foods to boost sperm quality.

Are there any Ayurvedic treatments or remedies to cure male infertility?

By Zaira Salvador BSc, MSc (embryologist).

Ancient Ayurvedic treatments, home remedies, homeopathy medicine, or even acupuncture are said to be useful when it comes to treating male infertility. However, to date, there is no scientific proof that these “natural” remedies can actually cure or help to cure infertility in males.

Does mumps cause infertility in males?

By Zaira Salvador BSc, MSc (embryologist).

Childhood diseases such as mumps or chicken pox normally run their course and end without significant long-term effects. However, when a boy or an adult man contracts mumps, it can affect the testes and cause a condition called orchitis.

The prevalence of orchitis in young adults and adults ranges from 20% to 30%. Only in a small percentage of mumps-induced orchitis, the male experiences a reduction in sperm production, probably linked to changes in male hormones during the earliest stages of orchitis.

Are men with Cystic Fibrosis sterile by default?

By Zaira Salvador BSc, MSc (embryologist).

Most men with Cystic Fibrosis (CF) are infertile because of a blockage or absence of the sperm canal, an alteration known as congenital bilateral absence of the vas deferens (CBAVD). Since the sperm are unable to make it to the semen, it is impossible for them to reach and fertilize an egg with intercourse.

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References

G.R. Dohle, T. Diemer, A. Giwercman, A. Jungwirth, Z. Kopa, C. Krausz (2010). Guía clínica sobre la infertilidad masculina. European Association of Urology 2010 (actualización en abril de 2010)

Griffin DK, Finch KA (2005). The genetic and cytogenetic basis of male infertility. Human Fertil;8(1);19-26

Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. (2001). Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med; 345: 1388-1393.

Juárez de Diego JF (1999). Principales causas de infertilidad masculina. En: Arrondo JL. Actualización en Andrología. Publimed Comunicación SL. Pamplona.

Male infertility best practice policy committee of the American Urological Association (AUA) (2010). The optimal evaluation of the infertile male. AUA Best Practice Statement. Revised,.

Matorras R, Hernández J (eds.) (2007): Estudio y tratamiento de la pareja estéril: Recomendaciones de la Sociedad Española de Fertilidad, con la colaboración de la Asociación Española para el Estudio de la Biología de la Reproducción, de la Asociación Española de Andrología y de la Sociedad Española de Contracepción. Adalia, Madrid.

Pierik FH, Van Ginneken AM, Dohle GR, Vreeburg JT, Weber RF (2000). The advantages of standardized evaluation of male infertility. Int J Androl; 23(6): 340-6.

Sociedad Española de Fertilidad (SEF) (2011). Manual de Andrología. Coordinador: Mario Brassesco. EdikaMed, S.L. ISBN: 978-84-7877.

World Health Organization (WHO) (2000). WHO Manual for the Standardized Investigation, Diagnosis and management of the infertile male. Cambridge: Cambridge University Press.

Speech of the Dr Ana María Segura Paños during the event organized by inviTRA in Valencia in 2013, fin the original video here.

FAQs from users: 'Why has sperm quality experienced such a dramatical decrease amongst males in the past few years?', 'Can HPV cause infertility in males?', 'Can Chlamydia cause infertility in males?', 'Can infertility in males be cured?', 'Does testicular trauma affect fertility?', 'Can problems with sperm cause miscarriage?', 'Does sperm quality decrease as a man ages?', 'Can male infertility be cured with diet?', 'Are there any Ayurvedic treatments or remedies to cure male infertility?', 'Does mumps cause infertility in males?' and 'Are men with Cystic Fibrosis sterile by default?'.

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Authors and contributors

 Ana María Segura Paños
Ana María Segura Paños
MD, MSc
Andrologist
Bachelor's Degree in Medicine and Surgery from the University of Alicante (UA), specialized in Andrology and Male Sexual and Reproductive Medicine. Associate physician at Andrology Unit of the University General Hospital of Alicante, and professor of Master's Degree in Human Reproduction from the Miguel Hernández University of Elche. More information about Ana María Segura Paños
License: 0306533
 Emilio Gómez Sánchez
Emilio Gómez Sánchez
BSc, PhD
Senior Embryologist
Bachelor's Degree in Biology from the University of Seville. PhD in Biology from the University of Valencia. Large experience as an Embryologist Specialized in Assisted Reproduction. Currently, he is the IVF Lab Director of Tahe Fertilidad. More information about Emilio Gómez Sánchez
License: 14075-MU
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Marie Tusseau
Marie Tusseau
inviTRA Staff
Editorial Director of Babygest magazine in French and English More information about Marie Tusseau

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