Even though male infertility is less common than female infertility, it can still be a contributing factor in about 40% of all infertility cases. At the America Institute of Reproductive Medicine – Alabama, Dr. Cecil A. Long offers infertility testing, diagnosis, treatments, and more to our patients experiencing trouble conceiving. He is a board-certified reproductive endocrinologist with more than 30 years of helping men with infertility. Dr. Long accepts patients by referral and through consultation requests. If you are concerned that you are experiencing male infertility, please make an appointment at our Birmingham, AL office today.
Causes of Male Infertility
Causes of male infertility include overall health and certain physical or hormonal conditions that can affect delivery, quantity, and quality of sperm. Generally, the first step in determining the cause of infertility in the male involves semen and sperm analysis. Some causes of infertility in men include:
- Sperm abnormalities
Size, shape, volume, and motility (movement ability) are important factors in male fertility.
Sexually transmitted diseases (STDs) or inflammation of the prostate or testicles.
An enlarged vein in the man’s scrotum that can affect sperm quality.
- Hormone imbalance
Hormonal levels that are too low or high may cause a problem with sperm quantity or quality.
- Blockage of the sperm duct
The vas deferens transports sperm for ejaculation, but sperm will not reach the egg.
- Retrograde ejaculation
This causes sperm to travel backward into the man’s bladder during ejaculation rather than out through the tip of the penis.
- Undescended testicles (cryptorchidism)
If not corrected, this can lead to low sperm production.
- Injury or trauma
This can cause damage to the testicles and production of sperm.
- Problems with sexual intercourse
Psychological and/or physical factors may make intercourse difficult or impossible for some men, like erectile dysfunction (ED), hypospadias, premature ejaculation, and painful intercourse.
- Cancer of the reproductive organs
Cancer can cause infertility, as can cancer treatments such as radiation or chemotherapy.
Low Sperm Concentration
Low sperm concentration and production are indicated by 20 million or fewer sperm per milliliter of semen. A normal sperm concentration is 40 – 300 million sperm per milliliter of semen. Causes of low sperm concentration include:
- Overheating the testicles
Frequent use of saunas or hot tubs can elevate core body temperature, which may impair sperm production and reduce the sperm count.
- Abuse of cocaine or marijuana
Drug use may temporarily lower the number and quality of sperm. The use of certain drugs can also contribute to male infertility. For example, anabolic steroids, which are testosterone injections that are frequently taken by bodybuilders and performance athletes, can cause the testicles to shrink and sperm production to decrease.
Men who smoke tobacco may have a lower sperm count than do those who do not smoke.
- Excessive or prolonged emotional stress
This may interfere with hormones needed to produce sperm, thus lowering the sperm count.
- Testicular abnormalities
A misshapen testicle can have a negative effect on sperm concentration. These abnormalities may include testicular inflammation/infection with resultant testicular scar tissue, varicocele, or an undescended testicle.
Abnormal Sperm Motility
Abnormal sperm motility will prevent the sperm from quickly and accurately penetrating the egg. Motility involves the number of active sperm and their quality of movement. Causes of abnormal and motility include:
Sexually transmitted diseases and mumps.
Swelling of the testicles, prostate, urethra, or epididymis (the tube that carries sperm from the testicle) can temporarily or permanently affect the motility of the sperm.
- Infrequent ejaculation
Refraining from sex or masturbation for more than 5 days can result in old sperm, which can inhibit fertility.
Impaired delivery of sperm to the egg affects the sperm’s ability to fertilize the egg. Causes of impaired delivery include:
Impotence can be caused by physical factors, but also by psychological and/or relationship issues and even painful intercourse, which can inhibit attempts to conceive.
- Intercourse that coincides with ovulation
Erectile dysfunction, premature ejaculation, or the incorrect timing of intercourse that does not attempt to coincide with ovulation can contribute to infertility.
Some lubricants can be toxic to sperm.
- Retrograde ejaculation (RE)
RE occurs when semen enters the bladder rather than emerging out of the body through the urethra. RE can be a result of diabetes, bladder, prostate or urethral surgery, or due to the use of certain medications.
Blockage of the epididymis or ejaculatory ducts can impair delivery.
- Cystic fibrosis
Men with cystic fibrosis or who are carriers of cystic fibrosis often have a missing or obstructed vas deferens. This means that even though normal sperm is produced, there is not an intact pathway to release the sperm through ejaculation.
Repeated bouts of STDs, such as chlamydia and gonorrhea, can cause scarring and block sperm passage.
- Zero sperm count
The absence of ejaculate may occur in men with spinal cord injuries or diseases.
- Female obstructions
Abnormalities of the female genital tract, such as toxic mucous and anatomical malfunction.
General Health Issues
General health issues that affect male fertility can be caused by:
Older men may be less fertile.
Body cells, including sperm cells, cannot function properly in an acidic and toxic environment. When the diet is nutrient poor and chemically loaded, the body eventually becomes toxic and disease follows. Specific issues include excessive caffeine intake and deficiencies in such nutrients as vitamin C, selenium, zinc, and folic acid.
Excessive stress, anxiety, lack of sleep, and exercise all adversely affect fertility. Infertility itself can sometimes become a long-term, discouraging problem, therefore producing more stress.
- Substance abuse
Alcohol or drug dependency can be associated with poor health and reduced fertility.
Those affecting reproduction can be infectious, such as STDs and viral infections like mumps, or they can be inflammatory, autoimmune diseases like multiple sclerosis. Certain conditions such as diabetes, thyroid disease, Cushing’s syndrome, or anemia may affect fertility.
- Environmental exposure to pesticides and other chemicals
Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Lead exposure may also cause infertility.
Cancer & Cancer Treatments
Cancer and cancer treatment can adversely affect a man’s fertility by damaging the male reproductive organs and sperm. Testicular and prostate cancers are the most common cancers resulting in male infertility. However, cancer treatments such as radiation and chemotherapy for any type of cancer can impair sperm production, sometimes causing irreversible damage to the cells responsible for producing sperm.
Male Infertility Reviews
"Dr. Long helped me and my husband get pregnant last year. He figured out exactly what was wrong with me and preformed my hysteroscopy and laparoscopy last April and we had our first and only IUI in May. We got pregnant on our first IUI. We used him at ART and continued to use art for the 12 weeks. Our whole experience was great and wish Dr. Long the best of luck!"- S.E. / Facebook / Jan 06, 2018
Testing for Male Infertility
Testing for male infertility is important. Common tests include:
Positive lifestyle changes such as losing weight or quitting smoking can have a positive effect on male fertility and quality of life in general.
Some men may qualify for a vasectomy reversal, which can enable sperm to be released again in a man’s semen during ejaculation.
IUI an effective form of artificial insemination, which involves the collection and washing of sperm. The cleaned sperm is injected directly into the uterus in hopes of natural fertilization.
In vitro fertilization
IVF with intracytoplasmic sperm injection (ICSI) is a procedure that involves a single sperm cell being injected into a single egg to create an embryo. The embryo is then implanted into the woman’s uterus.
Through a surgical procedure called sperm aspiration, a fertility doctor can insert a needle directly into the testicle or epididymis to extract the sperm. The sperm can then be used for IUI or IVF.
We can balance, regulate, or manipulate high or low hormone levels with medications or injections to help restore male fertility.