What You Should Know About Male Infertility

Some people pull out all the stops to improve their pregnancy odds. Preconception counseling? Fertility tracking? Check and check.

Unfortunately, the male partner's contribution to a couple's pregnancy plans tends to get glossed over. Sometimes, there's no guarantee their sperm will fertilize the egg cell.

Male infertility contributes to or causes about 40% to 50% of infertility in heterosexual couples. Before going forward with fertility treatments, like intrauterine insemination (IUI) or in vitro fertilization (IVF), couples may benefit from having the male partner's fertility tested first.

"A lot of guys are not being investigated," confirmed Keith Jarvi, MD, professor of urology at the University of Toronto, who presented preliminary survey results at the 2018 American Urological Association (AUA) annual meeting.

Dr. Jarvi explained that fertility testing is essential, as people may undergo fertility treatments not knowing their partner has infertility that they could potentially treat.

Health asked reproductive medicine and male fertility specialists to explain what people need to know about their male partners' sperm-making capabilities. Here's what you should know about improving the quality, quantity, and delivery of sperm. 

Are There Early Warning Signs of Infertility?

There aren't specific symptoms of male infertility. But certain risk factors may give you a reason to suspect it, which include:

• Sperm quantity and quality
• Certain chronic health conditions
• Hormonal imbalances
• Untreated sexually transmitted infections (STIs)
• Reproductive system impairments
• Depression
• Body weight
• Smoking
• Excessive heat
• Certain medications and supplements

Additionally, according to Dr. Jarvi, "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."

Also, if you're a woman with regular periods and no identifiable fertility issues but cannot become pregnant, "it makes you think there might be something going on with the man," James Hotaling, MD, a urologist specializing in male infertility and men's health at the University of Utah School of Medicine in Salt Lake City, told Health.

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

Common Misconceptions About Male Infertility

Certain myths about male infertility are essential to clarify, so that time and effort are spent on the things that affect fertility—positively or negatively.

Frequency of Sex

One of the most talked about points concerning male fertility is that frequent ejaculation, either during sex or masturbation, will lead to infertility. 

In one study published in 2015 in Reproductive Biology and Endocrinology, researchers analyzed daily semen samples for two weeks. The researchers concluded that daily ejaculation caused sperm counts to decrease. Still, daily ejaculation did not negatively impact sperm quality, motility, and vitality.

Additionally, although sperm counts decreased during the length of the study, it may not be a significant difference. 

"Most people are making about 1,000 sperm per second regardless of how often they ejaculate," noted Dr. Hotaling.

Too Much Cycling

People may conflate concerns that cycling impairs male fertility.

In one study published in 2018 in the Journal of Urology, researchers at the University of California in San Francisco surveyed more than 2,700 cyclists plus hundreds of runners and swimmers. The participants completed questionnaires on sexual health, prostate issues, urinary tract infections (UTIs), genital numbness, and other symptoms.

Due to cycling, the researchers hypothesized that bike-saddle pressure and trauma to the perineum, the area between the anus and scrotum, would be detrimental to erectile function. 

But, contrary to popular belief, the study found that 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.

Factors That Could Cause Male Infertility

A typical semen sample contains millions of sperm. But many things can affect the quality and quantity of those reproductive cells.

"If the total sperm count is 10 million, and 20% of them are motile, your total motile count is two million," explained Dr. Hotaling. "Ideally, you want that number over 20 million to have a really good chance of getting somebody pregnant naturally."

There are physical, environmental, and lifestyle factors can affect sperm count. But the good news is that many of those factors can be treated or reversed.

Overall Health

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

In some cases, low sperm count may be due to testicular failure caused by certain chronic health conditions, like:

• Type 2 diabetes
• Cystic fibrosis
• Certain autoimmune diseases
• Hormonal imbalances, like low testosterone

Untreated or poorly treated infections, like STIs, may also impact the quantity of sperm. However, as of December 2022, more research is needed to understand that relationship.

"Certain types of [STIs] can cause plumbing problems with the sperm and make it harder for the sperm to get out," explained Dr. Hotaling.

The Reproductive System

Fertility is tied to several aspects of the male reproductive system. If something interferes with proper function, then conceiving will be more challenging.

A common identifiable cause of male infertility is a varicocele, dilation of a testicular vein, typically in the spermatic cord above the testis. A varicocele reduces the quality and quantity of sperm, can lower the male hormone testosterone, or cause dull testis pain.

Unless it's an extreme case, most people don't know they have a varicocele until they see a healthcare provider. Surgery, commonly low groin surgery, sometimes done microsurgically or laparoscopically in adolescents, can help improve sperm quantity and quality. Surgery reduces heat effects on the testis caused by the varicocele.

"[A varicocele] can be fixed with a minor outpatient surgery," explained Dr. Hotaling. "The surgery takes about 45 minutes to an hour."

Following surgery, it typically takes about three to six months for sperm quantity and quality to improve. In about 0% to 35% of cases, varicocele reoccurs.

Depression

Couples experiencing infertility may be surprised to learn that depression could make conception more difficult than average.

In 2018, a team of researchers funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), using data from two prior studies, found that male partners with "currently active" depression were less likely to conceive following non-IVF fertility treatments than others.

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

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

Body Weight

For some women, being overweight or underweight can change their menstrual cycle, including when or if they ovulate.

And weight also makes a difference for men. For example, being overweight or obese can lead to low testosterone and elevated estradiol, a form of the hormone estrogen. Those fluctuating hormones can affect testis function and sperm quality and production.

In one study published in 2014 in Human Reproduction, researchers from Stanford University and the NICHD analyzed data from couples trying to conceive. The researchers found that the male's ejaculate volume decreased with increasing body mass index (BMI) and waist circumference. 

Likewise, the researchers found that if a male's waistline was larger than others, their sperm count was also lower than average. Other studies have also shown that obesity may lead to changes in sperm DNA and structure, increasing the likelihood of infertility.

However, it's not just being overweight that can lower sperm count. 

"If you're too [underweight], your sperm counts are low, too," added Dr. Jarvi.

Smoking

Studies have shown that smoking can damage the DNA, change the shape, and decrease the total count and motility of sperm.

In addition to tobacco, some evidence suggests that regular marijuana use reduces semen quality.

Excessive Heat

Sperm production may be temporarily impaired if the scrotum is exposed to excessive heat.

Limited evidence suggests frequent sauna or hot tub use may adversely affect sperm quantity and quality.

Additionally, there could be occupational hazards. Dr. Jarvi said that line cooks working in blazing hot kitchens for hours at a stretch might have fertility issues. Additionally, men who use laptops directly on their laps or cell phone in their front pockets may be at risk.

It's important to note that as of December 2022, studies investigating excessive heat and infertility have been small and measured differing outcomes. So, more research is needed.

Medications and Supplements

In addition to physical, environmental, and lifestyle factors, some medications and supplements may impact sperm quantity and quality, contributing to male infertility. 

Testosterone Supplements

Taking supplemental testosterone, either testosterone or anabolic steroids approved by the Food and Drug Administration, to bulk up muscle or boost stamina may contribute to male infertility.

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

Yet, according to survey data presented by Dr. Jarvi at the 2018 AUA annual meeting from 23 male infertility centers in Canada, nearly 5% of men were using testosterone at that time.

"The findings suggest that many men are not aware that taking these hormones may cause fertility issues," explained Dr. Jarvi. 

Male reproductive experts use certain off-label medications to treat low testosterone, such as clomiphene citrate, in men with fertility interests. That medication up-regulates the body's pituitary fuels and stimulates the testes. That mechanism is the opposite of typical testosterone products, which shut down the pituitary and shut off the fuels to the testes.

Medications for Thinning Hair

If your partner takes Propecia (finasteride) or Avodart (dutasteride) to treat hair loss, it may negatively impact their fertility.

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

"Yet, as many as one in 20 to 25 men in the 2018 survey of couples in fertility treatment were taking the medication," said Dr. Jarvi. 

In some men, when the medication is stopped, "their sperm counts rebound quite well," added Dr. Jarvi.

How To Reduce the Risk of Infertility

Luckily, you or your partner can do many positive things to improve sperm quality, quantity, and delivery. 

One of the first steps might be to see a healthcare provider for a physical exam to ensure there aren't any underlying health conditions impacting fertility.

According to one study published in 2020 in the Central European Journal of Urology, maintaining a healthy body weight, eating healthily, quitting smoking, and quitting smoking may help address some lifestyle risk factors impacting male fertility.

Also, building a support system can help with treating depression, as well as implementing other lifestyle changes. Having the proper support in place can help lifestyle changes be successful.

Fertility Testing

In addition to a physical exam, you can receive several tests to check fertility, which include:

• Semen analysis: This test takes a semen sample and sends it to a lab to measure the number, shape, and motility of sperm.
• Scrotal ultrasound: This imaging test produces pictures of the inside of the scrotum and checks for any irregularities, like a varicocele.
• Hormone testing: Your healthcare provider can take a blood sample to check your hormone levels. Hormones made by the pituitary gland and hypothalamus, which are parts of the brain, play a key role in making sperm.
• Genetic testing: This test is usually done to determine if there is a genetic cause for low sperm count.
  

A Quick Review

According to the American College of Obstetricians and Gynecologists (ACOG), if you've been trying to become pregnant for over a year—or six months if you're over 35 years old—you and your partner should take fertility tests.

Up to 50% of infertility occurs in males. Eating healthier, maintaining healthy body weight, quitting smoking, or treating depression may help address some common risk factors of male infertility. Also, building a support system can alleviate some of those challenges that may feel overwhelming.