12 Things You Should Know About Male Infertility

Read about these signs of infertility in men–and share it with your partner–if you're trying to get pregnant.

Some women pull out all the stops to improve their odds of getting pregnant. Preconception counseling? Fertility tracking? Check and check. Unfortunately, what tends to get glossed over is a man's contribution to a couple's baby-making plans. Without a robust supply of swimmers, there's no guarantee his sperm will hook up with your egg.

Male infertility contributes to or causes nearly half of all infertility cases, says the American Urological Association (AUA). Many couples forge ahead with fertility treatments, like intrauterine insemination or in vitro fertilization (IVF), even before a man's fertility is tested, a recent survey reveals.

"A lot of guys are not being investigated," confirms Keith Jarvi, MD, professor of urology at the University of Toronto, who presented these preliminary survey results at the AUA's 2018 annual meeting.

The upshot? Some women undergo fertility treatments for what is really "a male-factor problem" that has potentially reversible causes, he explains.

We asked reproductive medicine and male fertility specialists to give us the inside scoop on what women need to know about guys' sperm-making capabilities and what couples can do to improve the quality, quantity, and delivery of sperm, especially if they're struggling to conceive. Read on, and share this link with the man in your life.

It Doesn't Matter How Much Sex You Have

Never fear! Your partner's sperm supply won't dry up just because the two of you are having lots of sex or he's masturbating on the side.

"Most guys are making about 1,000 sperm per second regardless of how often they ejaculate," says James Hotaling, MD, an assistant professor of surgery (urology) at the University of Utah School of Medicine in Salt Lake City.

By the way, if he's aroused but doesn't have an orgasm and gets a painful case of "blue balls," no harm, no foul as far as his fertility goes.

"The guy's eventually going to ejaculate," Dr. Jarvi reasons, "so he's going to be okay."

His Sperm Count Could Be Low

A typical semen sample contains millions of sperm. But lots of things can affect the quality and quantity of those male reproductive cells, making it tougher for him to get you pregnant.

"If the total sperm count is 10 million, and 20 percent of them are motile [swimming], your total motile count is 2 million," Dr. Hotaling explains.

"Ideally, you want that number over 20 million to have a really good chance of getting somebody pregnant naturally," he says.

There Aren't Really Any Early Warning Signs

There aren't exactly symptoms of male infertility, but there are certain circumstances that could give you a reason to suspect a "male factor" problem.

"If your partner had cancer as a child, for example, or had surgery on the groin, he may be at higher risk for fertility issues," Dr. Jarvi says.

Or, if you're a 30-year-old woman who has regular periods and no identifiable fertility issues but you can't get pregnant, "it makes you think there might be something going on with the man," Dr. Hotaling adds.

"But there's no dead giveaway that it's a male issue," he says. "You have to test to assess that."

A Man's Fertility Is a Marker of Overall Health

Low sperm count can be "the canary in the coal mine," Dr. Jarvi says, "because it suggests that something's just not right with his health and should be investigated."

And, if the problem is due to some health, lifestyle, or environmental factor, it may actually be reversible or treatable.

A lower sperm count may be a sign of type 2 diabetes, for example, or a hormonal problem, like low testosterone.

It could also signal the presence of an infection. "Certain types of sexually transmitted diseases can cause plumbing problems with the sperm and make it harder for the sperm to get out," Dr. Hotaling says.

His Reproductive Equipment Can Cause Problems

It's not just about getting and maintaining erections. Fertility can flatline if other aspects of his reproductive system are in disrepair.

The most common identifiable cause of male infertility is a "varicocele," which is an enlarged vein in the scrotum. It reduces the quality and quantity of a man's sperm.

Unless it's an extreme case, most guys don't know they have one until they see a physician, Dr. Hotaling says. "It can be fixed with a minor outpatient surgery," he explains. "The surgery takes about 45 minutes to an hour," he says, and when the problem is fixed, "it comes back less than 1 percent of the time."

Testosterone Supplements Squelch Sperm Supply

Men who take supplemental testosterone to bulk up or boost their stamina aren't doing their chances of fatherhood any favors.

"What happens is you're shutting down your own production of testosterone from the testicles," Dr. Jarvi explains. "So, big muscles; small testicles."

Yet survey data from 23 North American male infertility centers showed close to 5 percent of men were using testosterone. "The findings suggest that many men are not aware that taking these hormones may cause fertility issues," he says.

You May Be Less Likely To Conceive if He's Depressed

Infertile couples may be surprised to learn that a man's depression could pose a hurdle toward conception.

Using data from two prior studies, a team of U.S. researchers funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) found that women whose male partners had "currently active" major depression were less likely to conceive following non-IVF fertility treatments.

"Couples without male depression had over twice the pregnancy rate than couples with male depression," says lead author Emily Evans-Hoeker, MD, a reproductive endocrinologist and an assistant professor of obstetrics and gynecology at Virginia Tech Carilion School of Medicine in Roanoke, Virginia.

While the exact cause is unclear, the team suspects that erectile dysfunction, decreased intercourse frequency, and/or delayed or inhibited ejaculation may play a role. It's also possible that depression and antidepressant use may impact sperm quality.

RELATED: 12 Types of Depression, and What You Need to Know About Each

His Spare Tire Could Be a Problem

Being overweight or underweight can mess with your ovulation. But did you know your guy's weight also makes a difference?

When Stanford University and NICHD researchers analyzed data from couples trying to conceive, they found that men's ejaculate volume decreased with increasing body mass index and waist circumference. Also, the larger a man's waistline, the lower his sperm count. The study is said to be the first to show a relationship between waist circumference and sperm quality in men without known infertility.

And, it's not just heavier men who have a problem. "If you're too light, your sperm counts are low, too," Dr. Jarvi adds.

Fathering a Healthy Baby May Be Motivation to Finally Quit Smoking

Men who smoke jeopardize their fertility every time they light up. The reason? Male smokers are more likely to have damaged DNA in their sperm, according to the U.S. Centers for Disease Control and Prevention (CDC).

Secondhand smoke also poses a danger to your health and that of your unborn child.

Tobacco isn't the only problem. There's also evidence that regular marijuana use reduces semen quality.

Meds for Thinning Hair and Fertility Don't Mix

If your partner is taking Propecia (finasteride) to treat hair loss, it could be putting a crimp in his sex life and your baby-making plans.

Common side effects include loss of libido, erectile dysfunction, and abnormal ejaculation. It can also cause poor semen quality and infertility.

"Yet, as many as one in 20 to 25 men in the multicenter study of couples in fertility treatment were taking the medication," Dr. Jarvi says. In some men, when the medication is stopped, "their sperm counts rebound quite well," he adds.

His Swimmers Can't Stand the Heat

Sperm production may be impaired (at least temporarily) if your man's scrotum is exposed to excessive heat.

While more research is needed, there's some evidence that frequent sauna or hot tub use may be detrimental, and there could be occupational hazards, too. Line cooks working in blazing-hot kitchens for hours at a stretch or men who use laptop computers on their laps can have fertility issues, Dr. Jarvi notes.

Cycling Probably Doesn't Wreck His Sex Life

Concerns that cycling is harmful to a man's sexual function may actually be overblown.

In the largest study of its kind, researchers at the University of California-San Francisco surveyed more than 2,700 cyclists plus hundreds of runners and swimmers. Participants completed questionnaires on sexual health, prostate issues, urinary tract infections, genital numbness, and other symptoms.

Researchers hypothesized that bike-saddle pressure and trauma to the perineum, the area between the anus and scrotum, due to cycling would be detrimental to erectile function. But, contrary to popular belief, cyclists had no worse sexual outcomes than non-cyclists. (However, some were more prone to urethral stricture, a narrowing of the tube through which urine passes.)

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