What Causes Male Infertility? - Path Fertility

What Causes Male Infertility?

10 Common Causes for Male Infertility

Medically Reviewed by Dr. Kevin J Campbell, MD, a fellow in Male Reproductive Medicine and Surgery at Bayor College of Medicine in Houston, TX, with Dr. Larry Lipshutlz. 

On your path through fertility care, it’s easy to forget that men are half the equation-50% of infertility cases may be attributable to a male factor. This is unfortunate because testing for male infertility is often simple, low cost, and non-invasive. More importantly, many causes can be successfully treated.
To eliminate the stress and time of the research process, we created an easy to understand 10-step explainer about male infertility causes and treatment options for couples trying to get pregnant.

1. Infertility Impacts 15% of All Couples

Infertility is defined as the inability to conceive a child within one year of unprotected sexual intercourse. What’s not always appreciated is that in 50% of the cases, men play a significant role in the couple’s infertility. Another way of looking at this is that up to 7% of men may suffer from infertility. Illness, injury, age, chronic health problems, lifestyle choices, and other factors can contribute to male infertility.

2. How Babies are Made – Sex Education

Sperm are created from primordial germ cells in the testes. Combined with nutritive fluid from the prostate gland, around 300 million sperm form the ejaculate. On the female side, women ovulate once per month, sending an egg down into the uterus. Sex anytime within the five days before ovulation may lead to a pregnancy. After conception, the combination of the sperm and egg leads to embryogenesis (the first stages of new life).

3. Common Causes of Male Infertility

Male factor infertility contributes to the couple’s infertility in about 50% of the cases.

A few causes are:

  • Varicocele (enlarged veins in the testicles)
  • Undescended testicle
  • Infection in the testicle or prostate
  • Chemotherapy for cancer
  • Anabolic Steroids
  • Genetic Abnormalities
  • Endocrine Abnormalities
  • Ejaculatory Dysfunction

An estimated 20-35% of men are “diagnosed” with unexplained infertility. Meaning that all the diagnostic tests look normal for them and their spouse, however, they are still unable to conceive without knowing why.

4. Factors that Increase Risk of Male Infertility

A number of risk factors are linked to male infertility, including:

  • Aging
  • Smoking tobacco or marijuana
  • Drinking alcohol excessively
  • Being overweight
  • Exposure to environmental toxins
  • Having past or present infections
  • Overheating the testicles
  • Having medical conditions, including tumors and chronic illnesses
  • Taking medication or undergoing medical treatment such as radiation for cancer
  • Testosterone therapy

5. Unexplained Infertility

Unexplained infertility affects 20-35% of all infertile couples. Unexplained infertility is when the cause remains unknown even after all the available diagnostic testing has been completed. This usually includes the semen analysis in the man and the assessment of ovulation and fallopian tubes in the woman. To be clear, abnormalities are still likely to be present in cases of unexplained infertility, but not detectable by current diagnostic methods.

6. The Semen Analysis Test

The semen analysis is a fundamental lab test for testing infertility that assesses several parameters, including the number of sperm in a given sample, the motility of those sperm (can they move properly?), and the morphology (do they look normal?). This test also typically looks for signs of inflammation or infection (i.e., so-called “round cells” in the semen sample, which must then be differentiated from sperm germ cells). Although the semen analysis is a reasonable first test for assessing the male, it does not provide an overall evaluation of the fertility of the man. In other words, just because your semen parameters are normal doesn’t necessarily mean you’re fertile. Remember, a large proportion of infertile men are diagnosed with unexplained infertility.

7. DNA Fragmentation Testing

DNA fragmentation is the separation or breaking of DNA strands into pieces. If a doctor suspects DNA fragmentation as a cause of infertility they can order a test to identify what percent of the DNA in a man’s sperm in fragmented.  Common DNA fragmentation tests include the Tunel assay, Comet assay, or the Sperm Chromatin Structure Assay test.

8. Advancements in Testing for Male Infertility

Advancements in diagnosing male infertility has been very limited over the last several decades. In fact, one of the more recent advancements was the discovery of DNA fragmentation as a biomarker for helping understand IVF cycle failures, which was discovered in 1980. 

Advanced Sperm Quality Testing. Easy, Mail-in Kit.

9. Treatment of Male Infertility

The goal of fertility treatment is conception, pregnancy, and the birth of your child. If surgical approaches, such as varicocele repair, do not correct the infertility, additional therapies may be used. Intrauterine insemination (IUI) involves washing ejaculated sperm and introducing the specimen into the cervix with a special pipette during a modified gynecological exam. In cases of very low or absent ejaculated sperm counts, sperm are typically collected from the ejaculate or through surgical testicular extraction and introduced to the egg through assisted reproduction therapies such in-vitro fertilization (IVF), or injected directly into the egg (IVF-ICSI). Success rates and costs vary for each technique, but typically IVF and IVF-ICSI are more successful, statistically, than IUI.  Financial costs may range, though IVF/ ICSI may increase these by about 10X.

10. Approaching Infertility & Treatment

Coping with infertility can be difficult and the journey through treatment can be long and stressful. Specifically, it’s an issue of the unknown – you can’t predict how long treatment will take and what the outcome will be. The emotional burden on the couple is considerable. Talking with your partner about expectations and putting together a mutually agreed upon plan will help weather the process. Decide in advance how many and what kind of procedures are emotionally and financially acceptable for you and your partner and determine a final limit.

Kristin Brogaard, PhD

Kristin Brogaard, PhD is Co-founder and COO of Inherent Biosciences, a molecular diagnostics company at the intersection of epigenetics and AI. Dr. Brogaard is an experienced molecular biologist, study director, and operations manager for early stage biotech startups. She received her PhD in Molecular Biology from Northwestern University developing novel epigenetic technologies. She subsequently worked with Dr. Leroy Hood, a pioneer in personalized medicine technologies, first as a post-doc and then as a colleague launching a novel scientific wellness start-up, Arivale. Dr. Brogaard has broad business experience that includes launching and scaling the health startup, Arivale. Additionally, Dr. Brogaard was the Director of Program Management at Arivale managing all strategic projects with a highly qualified team of program and project managers.

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