What Are the Top 4 Causes of Male Infertility?

Infertility is a condition where a heterosexual couple cannot conceive a baby after having unprotected sexual intercourse for six to twelve months. The top four causes of male infertility are sperm disorders, physical issues, genetic disorders and gender transition.

Infertility is a common issue that couples face. Experts estimate that 1 in 7 couples are unable to conceive a child without medical assistance. There are many reasons that a couple might have trouble conceiving.

About 30% of infertility situations are due to male infertility. This means that there is some problem that is preventing sperm from connecting with your partner's egg.

Learn more about male infertility facts. 

If a heterosexual couple cannot conceive a baby after having unprotected sexual intercourse for six to twelve months, doctors will diagnose infertility. At that point, both partners will need more testing to learn the specific cause of the problem. There may be more than one factor causing them to be infertile. 

To determine if male infertility is a factor, your doctor will ask about your health history and do a physical exam. You may also need blood tests. After that, they may ask for a sperm sample that they can analyze in a lab.

Typically, adult human testicles produce millions of sperm per day. Sperm carry half the genetic code for making a baby. An ova, or egg, carries the other half of the genetic code. When sperm meets egg, they form a gamete that will develop into a baby.

Sperm are single-cells that have an oval-shaped head and a long tail. The tail allows them to swim through your body and into your partner's body toward the egg. Both the form and the function of sperm are important to conception. 

If you have a low number of sperm, you may not be able to successfully fertilize an egg. Additionally, if sperm are underdeveloped or aren't mobile, they may not be able to move toward the egg or penetrate it when they get close to it. 

There are multiple reasons for sperm problems, including:

• Past infections or illnesses, such as mumps or cancer, that affected your ability to make sperm
• Hormone or pituitary gland problems
• Immune disorders that cause your body to attack your own sperm
• Lifestyle factors such as tobacco use, heavy drug or alcohol use, or exposure to certain toxins 
• Underlying health conditions such as diabetes, immune disorders, or cystic fibrosis

Some conditions prevent sperm from leaving your testicles. Swelling or scarring inside the testicles can block the vessels that sperm travel through to leave the body. Sexually transmitted infections can lead to this type of problem. 

Varicocele‌

One common cause of infertility is a condition called varicocele. This happens when a blood vessel inside your testicle gets swollen or twisted. It can block the tube that allows semen to exit the body when you ejaculate. Varicocele can be often treated with a simple procedure to move the vessel out of the way. 

Retrograde ejaculation

Some people are unable to ejaculate semen. There is a condition called retrograde ejaculation, where your semen circles back into your bladder instead of exiting the tip of your penis. Causes for this include: 

• Past surgeries such as operations on your bladder or lymph nodes
• Certain medications, such as blood pressure drugs
• Nerve damage from conditions such as diabetes or multiple sclerosis

A handful of genetic conditions can lead to infertility, such as:

• Klinefelter's syndrome
• Y-chromosome microdeletion 
• myotonic dystrophy

If you have any of these conditions, talk to your doctor about how they will affect your fertility. 

Hormone replacement treatment for gender transition can affect sperm production. If you were assigned male at birth but took hormones for gender affirmation, your fertility may be compromised. Even if you retained your penis and testicles, you might not produce viable sperm. You can discuss options for preserving sperm before you begin transitioning if you want to conceive children at a later time.‌‌

If you were assigned female at birth, you would not be able to produce sperm even if you have fully transitioned to male. Hormone treatments, phalloplasty, or other transition care will not result in fertility. At this time, there is no treatment that can create fully functional testicles.

If you have been diagnosed with infertility, talk to your doctor about your options for starting a family. Some types of infertility can be treated with surgery or medication. Other situations are best addressed with assisted reproductive technology (ART). Doctors can collect sperm, test it for viability, and then use it for intrauterine insemination (IUI) or in-vitro fertilization (IVF).

If ART is not an option for you, you and your partner might consider adoption. Other couples choose to become foster parents to children in need.