On the surface, while starting a family can seem straightforward, the process goes awry more often than you’d expect. Infertility affects roughly 1 in 6 people worldwide, according to the World Health Organization. In the US, around 15% of couples have issues conceiving, and about 50 percent of the time, male infertility is a contributing cause.
If you’ve been trying to get pregnant and suspect you’re one of the 15%, don’t panic. There are plenty of tests and treatment options available that can boost your odds of conception. Since infertility can stem from an issue from either or both partners, it’s important for both to get tested to determine the roots of the problem.
There may be no obvious signs or symptoms of male infertility—and should you decide to investigate—here’s what that journey might look like.
Diagnosing male infertility
Usually, the first step in diagnosing male infertility is a visit with your primary care physician (PCP), who will go over your medical history and do a physical exam to assess your overall health and identify any problems that might be impacting your fertility.
They will also do a round of blood tests to check hormone levels and rule out other problems that can affect sperm production, followed by a semen analysis to check the amount of sperm you produce, how well they move and what shape they are, says Dr. Katherine Rotker, a urologist specializing in male fertility at Yale Medicine in New London, Connecticut.
Should anything from this assessment indicate an underlying fertility issue, you’ll be referred to a specialist—in this case, a urologist who specializes in male infertility.
No special preparation is needed for this appointment, she adds, but knowing the details of your medical history and family’s medical history is a crucial part of the diagnosis process. You should also bring the results of any fertility evaluations your partner has completed so far.
Once you’re there, the urologist will conduct an exam of the penis and surrounding areas. If the idea of an exam makes you squirm, have no fear: “The exam isn’t painful and is generally very quick,” says Dr. Philip Cheng, a urologist with Reproductive Medicine Associates of New Jersey. “Any findings will be reviewed and a recommended path forward will be discussed.”
Depending on these findings, your provider can make a treatment plan right after the first visit or conduct further testing, such as an ultrasound (to check your testicles and scrotum—the outer casing that protects the testicles—for problems) or genetic tests (to diagnose congenital or inherited conditions).
Causes of male infertility
Male infertility is usually caused by some combination of sperm disorders, structural problems or collateral damage from past or real-time health issues. Once all your test results are in, your provider should be able to offer some explanation for your issues.
Sperm disorders
The most common causes of male infertility involve problems with making healthy sperm, including:
- Low sperm production or motility:“If there’s low sperm production or motility, there may not be enough moving sperm present for a healthy, motile and viable sperm to reach the egg, penetrate, fertilize and lead to pregnancy,” Cheng says.
- Misshapen sperm:There may be an adequate number of sperm present, but not enough sperm with a normal shape (an oval head with a long tail). Abnormal sperm have head or tail defects—say, a large head or a double tail—and these defects might affect the sperm’s ability to achieve fertilization and pregnancy.
- No sperm in the semen:In rare cases, men will have no sperm in the ejaculate, which makes natural conception impossible. “These cases can be broken down into obstructive (meaning there’s a blockage) or non-obstructive (the body’s not producing sperm),” Rotker says.
Structural problems
Genital tract obstructions can derail the flow of semen and cause male infertility. Among the possible culprits:
- Swollen veins: Varicoceles, which are thought to be caused by malfunctioning valves in veins in the scrotum (located right above the testicles), can be a potential cause of infertility. Usually, these veins help maintain blood flow to the testicles, but if the valves aren’t working properly they can become swollen. The enlarged veins are thought to keep the area around the testicles too warm, which can impact sperm production, Rotker says.
- Sperm blockages: If your medical history includes a prior vasectomy (a procedure that cuts off the supply of sperm to the semen so as to prevent pregnancy) or congenital problems (such as being born without vas deferens, the ducts that deliver sperm to the semen), these can all interfere with your ability to conceive.
- Ejaculation issues: Various health conditions—diabetes, spinal injuries, urethra surgery, among others—can cause anejaculation (when you have an orgasm but no semen is released) or retrograde ejaculation (when semen enters the bladder during orgasm instead of exiting out of the tip of the penis).
Underlying health issues
Certain conditions, past and present, might put you at a higher risk of having male infertility, especially:
- Chronic infections: Some health issues, such as urinary tract and sexually transmitted infections (chlamydia, gonorrhea) can interfere with sperm production or sperm health, as well as cause scarring that can block the passage of sperm. “Men who’ve had chronic prostatitis—inflammation of the prostate gland—may be at risk for infertility as well,” says Dr. John Norian, a reproductive endocrinologist at HRC Fertility in California.
- Poorly controlled medical conditions: Obesity, elevated blood pressure and diabetes are some of the conditions that can lead to worse semen parameters and male infertility, Norian says. Poorly controlled hypertension and diabetes can also increase the risk of erectile dysfunction, making it even harder to conceive naturally.
- Substance and drug exposures: Men who are heavy substance users (alcohol, cigarettes, cannabis), have undergone prior cancer treatment (chemotherapy, radiation) and take certain medications (anabolic steroids, some ulcer and arthritis drugs) are all at higher risk for experiencing infertility. These substances and drugs are gonadotoxic, Cheng says, which means they can cause temporary or permanent damage to the body’s ability to produce sperm.
Treatment options for male infertility
“There’s no one-size-fits-all when it comes to treating male infertility,” Cheng says. “The treatment options you’ll be a candidate for will depend on the specific underlying causes of your fertility issues.”
Because male and female causes of infertility tend to co-exist, it’s recommended that your partner get tested and treated in tandem for maximum efficacy. But even if the exact cause of male infertility isn’t entirely clear, your doctor can still recommend treatments and procedures to boost your odds of conception. These might include any combination of the following:
Lifestyle changes
Best for treating: Poorly controlled medical conditions, substance and drug exposures
“Sperm disorders, such as low sperm count and motility, can be further exacerbated by an unhealthy lifestyle,” says Dr. Shvetha Zarek, medical and practice IVF director at Oma Fertility in St. Louis.
Lifestyle changes, such as spending less time sedentary, exercising more, eating lots of fruits and veggies, and nixing cigarettes, marijuana and alcohol from your repertoire might not be measurable ways of boosting your odds of conception, but it stands to reason that if your body’s healthier, your sperm will be too.
Medications and behavioral techniques
Best for treating: Chronic infections, poorly controlled medical conditions and ejaculation issues
“Sexual dysfunction is one of the most common causes of infertility that I see,” Cheng says. “If a couple is unable to have intercourse that ends with ejaculation of semen, they will be unable to conceive naturally.”
Treatment of erectile dysfunction and premature ejaculation, for instance, can involve a combination of medication and behavioral techniques (such as cognitive behavioral therapy and Kegel exercises).
It’s also important to be diligent about treating infections as they arise: “Some infections of the genital and urinary tracts can have a negative impact on sperm,” Cheng says.
Hormone imbalances—high or low levels of certain hormones or problems with the way your body uses them—can affect how sperm develop too, in which case your doctor might recommend hormone replacement or medications.
Penile vibratory stimulation (PVS) and electroejaculation (EEJ)
Best for treating: Anejaculation and retrograde ejaculation
PVS and EEJ are two non-surgical options of retrieving sperm—the former involves placing a special vibrator at the tip of the penis, the latter uses a probe that sends electrical energy to the reproductive tract, with the end goal of causing an erection and collecting the sperm.
Assisted reproductive technology (ART)
Best for treating: Low sperm production or motility, abnormal sperm, obstructive and non-obstructive azoospermia
ART treatments involve obtaining sperm, either through normal ejaculation or surgical extraction, and using it to boost your chances of conception through procedures like:
- Intrauterine insemination (IUI), the process of placing the sperm at the entrance of the cervix or directly into the uterus.
- In-vitro fertilization (IVF), where eggs are surgically retrieved from the ovaries and combined with sperm in the lab to make embryos to be inserted into the uterus. “IVF is a great option for men with very low sperm counts,” Cheng says.
- Intracytoplasmic sperm injection (ICSI), a procedure that involves hand-selecting viable sperm and individually injecting them into each egg—an especially helpful option for men with misshapen sperm, Cheng says. The resulting embryos are eventually inserted into the uterus.
Microdissection testicular sperm extraction (microTESE)
Best for treating: Non-obstructive azoospermia.
When there’s no sperm in the semen due to a production problem, a procedure called microTESE can be done to retrieve sperm directly from the testes, Cheng says. It involves making a small incision and using a microscope to hunt for sperm, with retrieval rates of 40% to 60%, according to the Mayo Clinic. The sperm can either be used right away to fertilize an egg or frozen for a later infertility treatment.
Seminal vesiculoscopy (SV) or transurethral resection (TR)
Best for treating: Ejaculatory duct obstructions.
Some men or people assigned male at birth have a blockage of sperm at the ejaculatory ducts that can be relieved through a small procedure, Cheng says. SV uses a small telescope to reach and remove the duct blockage, while TR involves cutting out the blockage.
Varicocelectomy
Best for treating: Varicoceles.
“Surgical treatment for enlarged veins in the scrotum can lead to improvement in sperm parameters in about 2/3s of patients,” Cheng says. The procedure involves sealing off the affected vein and redirecting blood flow into healthy veins.
Vasectomy reversal
Best for treating: Vasectomies.
A vasectomy reversal allows couples to conceive naturally, with pregnancy rates post-surgery ranging from 30% to over 90%, depending on the type of procedure, according to the Mayo Clinic. The process involves putting the vas deferens back in business so they can deliver sperm from the testicle into the semen.