Male Factor Infertility

Common Fertility Problems
Key Points

  • Male factor accounts for 30% of all infertility cases.
  • There are several causes of male infertility.
  • First line and further investigations are required to choose the best treatment.

Male Fertility

The male reproductive system produces, stores, and transports sperm. These processes are controlled by hormones.

The testicles are in the scrotum. When the sperm leave the testicles, they go into a tube behind each testicle called the epididymis. Just before ejaculation, the sperm go from the epididymis into another set of tubes called the vas deferens. Each vas deferens leads from the epididymis to behind the bladder in the pelvis. There each vas deferens joins the ejaculatory duct from the seminal vesicle. In ejaculation, the sperm mix with fluid from the prostate and seminal vesicles. This forms semen. Semen then travels through the urethra and out of the penis.

Around 30% of infertility cases are related to male factor issues. However, a lot of couples go through fertility treatment without in depth evaluation of any possible male factor problems.

Causes of Male Factor Infertility

There are several factors that can contribute to male factor infertility.

1.Sperm disorders: includes sperm that hasn’t developed or matured, that has an odd shape, that doesn’t move the right way or the number is low or inexistent.

2.Structural abnormalities: Obstructions at any point of the reproductive tract, preventing sperm to move. Can be caused by surgery, repeated infections, swelling or congenital defects.

3.Undescended testicles: when one or both testicles fails to descend from the abdomen into the sac that normally contains the testicles (scrotum).

4.Varicocele: swollen veins in the scrotum, happening in 16 out of 100 of all men. Varicocele blocks proper blood drainage and makes the testicles too warm, damaging sperm.

5.Retrograde ejaculation: when semen goes backwards in the body, into the bladder instead of out of the penis. It happens when nerves and muscles in the bladder don’t close during orgasm. It can be caused by surgery, medications or health problems of the nervous system. Signs include cloudy urine after ejaculation.

6.Immunological disorders: sometimes a man's body makes antibodies that attack his own sperm. Antibodies are most often made because of injury, surgery or infection. They keep sperm from moving and working normally.

7. Hormonal disorders: infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands.

8. Chromosomes: changes in the number and structure of chromosomes can affect fertility.

9. Infections: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhoea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.

10. Prior surgery: certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

11. Environmental causes: overexposure to certain elements such as heat, toxins and chemicals can reduce sperm production or function.

12. Lifestyle: drug use, including steroids, drinking alcohol and tobacco affect sperm. Prolonged emotional stress can also affect sperm count. Obesity can impair male fertility

Diagnosis of Male Factor Infertility

  • History and Physical Exam: including questions that may indicate to any of the causes discussed before.
  • First investigations: semen analysis to check sperm concentration, motility, morphology and seminal fluid parameters.
  • Further investigations: sperm viability, sperm membrane function, hormonal assays, MRI of the pituitary and hypothalamus, transrectal ultrasound, testicular biopsy.

Treatment of male factor infertility

Treatment depends on what's causing infertility:

  • Non-surgical therapy: may include lifestyle changes, medications, antibiotics, electroejaculation.
  • Surgical therapy: can be used for varicocele treatments, removal of blockages, surgical sperm retrieval (TESE, TFNA, PESA, MESA)
  • Treatment for unknown causes: IUI, IVF, ICSI

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