How Common Is Male Infertility? Risk Factors

Infertility is a diagnosis given to couples who have been attempting to conceive for a year and have been unsuccessful. 

Male infertility occurs when a sexually active male who is not using contraception discovers that their partner is not pregnant after a year of regular intercourse.

Most men who have infertility issues have normal sexual function and pass standard medical testing. Male infertility is thus diagnosed with two sperm tests, taken one month apart.

A sperm sample is collected after the patient has not ejaculated for at least 2 days but no more than 5 days. An abnormal sperm sample may reveal:

• No sperm (azoospermia)
• Low sperm count (oligozoospermia)
• Abnormal sperm
• Sperm that does not move as it should
• No ejaculation (aspermia)

If low sperm count is discovered, blood tests to assess hormone levels, such as follicle-stimulating hormones (FSH), testosterone, and prolactin, may be ordered. A high FSH level paired with a low testosterone level indicates testicular failure. 

In some cases elevated prolactin level may indicate a pituitary tumor, in which case a brain magnetic resonance imaging scan may be required.

In most cases, there may be no discernible signs or symptoms of male infertility, making it hard to diagnose. However, in some cases patients may notice the following symptoms:

• Problems with sexual function
• Difficulty ejaculating
• Decreased sexual desire
• Erectile dysfunction
• Pain, swelling, or a lump in the testicles
• Respiratory illnesses
• Abnormal breast enlargement (gynecomastia)
• Reduced face or body hair

Medical treatment may be necessary if you have:

• Erection or ejaculation issues
• Low sex drive 
• Testicular pain, discomfort, or swelling
• History of testicular, prostate or sexual dysfunction
• Surgery to the groin, testicle, penis, or scrotum

Although the exact cause of male infertility is often unknown, risk factors include:

• Low sperm production
• Abnormal sperm
• Barrier or obstruction preventing sperm from reaching the egg
• Anatomical problem that affects the reproductive system
• Hormonal imbalance
• Untreated chronic disease, such as diabetes or thyroid disorders
• Autoimmune disorders
• Obesity
• Advanced age
• Smoking
• Excessive drinking
• Illicit drug use
• Extreme temperatures
• Exposure to toxic chemicals
• Certain medications and drugs such as testosterone therapy or steroids
• Cancer treatment
• Genetics

Treatment for male infertility may include:

• Surgery to correct underlying anatomical conditions that may be causing obstruction
• Antibiotics to treat infections of the reproductive system
• Medications to treat erectile dysfunction or premature ejaculation
• Hormone therapies and drugs to correct hormonal imbalances
• Assisted reproductive technology (ART) to extract and inject sperm into the female vaginal canal, either by in vitro fertilization (IVF) or intracytoplasmic sperm injections (ICSI)