Infertility is when a couple aren't able to conceive after one year of having frequent, unprotected sex. There are a number of things that can affect fertility, although often no cause can be found.
Approximately one in ten couples worldwide have trouble conceiving. However, it's important to remember that more than eight in 10 couples will conceive within one year of having regular, unprotected sex.
Infertility is defined by the World Health Organization as not getting pregnant within one year of having frequent, unprotected sex. You may have primary infertility – this means you and your partner have never previously conceived a pregnancy together – or secondary, which is when you have.
Symptoms of male infertility
There aren't any specific symptoms of infertility, but if the problem is caused by a particular medical condition, you may have symptoms as a result of that.
Causes of male infertility
It may not be possible to find a cause for your infertility, however, common causes are explained below.
The most common reason for male infertility is a problem with your sperm. It may be that:
• you don't have enough sperm in your semen
• your sperm don't move as fast as they need to
• your sperm are the wrong shape
Usually these three features occur together.
Men who have problems with fertility may have no sperm at all in their semen (azoospermia). There are many reasons why this may be, but the most common cause is a condition called obstructive azoospermia.
This is when you don't have any sperm in your semen because there is a blockage in both of your seminal ducts (the tubes that carry sperm from your testicles to your penis). The blockage may be in the epididymis, vas deferens or ejaculatory duct, which are all part of your seminal ducts. The obstruction may be:
• congenital – this means you were born with it and often it isn't possible to find a cause
• acquired – this means you developed the condition as a result of an infection or surgery in the area
Your fertility problems may be a result of a condition known as hypogonadism – this may be congenital or acquired. If you have hypogonadism, it means that you don't produce enough or any of the hormone testosterone.
Congenital causes include being born with one or no testicles, or conditions that affect your hypothalamus and pituitary gland, which are important for hormone production.
These conditions are often the result of a genetic problem. Acquired hypogonadism may occur after an illness or accident, or as a result taking with certain medicines.
Testosterone has many functions in your body, but in particular it's essential for healthy development of the male genital organs and production of sperm. You also need testosterone to get an erection and to maintain your sex drive (libido).
For some men, fertility problems may be caused by a problem with ejaculation. Some of these are explained here.
• Anejaculation is when you don't produce any semen.
• If you have anorgasmia, this means you don't reach an orgasm or ejaculate.
• You may need more stimulation than usual to ejaculate – this is called delayed ejaculation.
• Retrograde ejaculation means the semen you produce moves backwards into your bladder instead of being ejaculated outside your body when you orgasm.
Factors affecting fertility
There are a number of factors that can affect your fertility, including:
• smoking, also if your mother smoked during pregnancy
• drinking alcohol excessively
• taking illegal drugs, such as cannabis and cocaine
• using anabolic steroids
• having chemotherapy or radiotherapy
• being overweight or obese
• the temperature of your scrotum being too high – this may be a result of being exposed to heat as part of your job, wearing underwear that is too tight, or often using a laptop computer on your lap
• certain jobs – for example, if you're exposed to some chemicals found in pesticides or solvents
• some medicines, such as sulfasalazine or cimetidine
It's not known whether a man's fertility declines as he gets older.
Diagnosis of male infertility
See a doctor if you're concerned about your fertility. If possible, it's a good idea for you and your partner to go together. Your doctor is likely to ask you for how long you have been trying to have a baby and whether you have had any problems having sex.
He or she may ask you about your lifestyle and medical history including whether:
• you have had children with a previous partner
• you have ever had any sexually transmitted infections (STIs), serious long-term diseases or other conditions that can affect fertility
• you're taking any medicines
Your doctor may also need to examine you.
If you have not already been doing so, your doctor is likely to recommend that you have unprotected sex two to three times a week for a year before carrying out any tests. After this time, or sooner if you or your partner have a condition that means you're less likely to conceive, there are a number of tests that he or she may do.
Your doctor may suggest a test to check if you have been infected with chlamydia. He or she is also likely to ask you to provide a sample of semen so it can be tested for a number of things, including how many sperm it contains and how fast they are able to move.
If this shows any problems, you may be asked to repeat the test. If there is a problem with your sperm, your doctor may refer you to a fertility specialist for further tests to see what is causing this.
Your fertility specialist is likely to examine you if you have a sperm problem. He or she may also recommend you have further tests, which may include hormone checks, chromosome tests and a screening test for cystic fibrosis.
For some men, a fertility specialist may recommend a special test to check for damage to the DNA of their sperm.
Please note that availability and use of specific tests may vary from country to country.
Treatment for male infertility
Your treatment will depend on what is causing your fertility problems.
Having sex two to three times a week is thought to maximise the chance of your partner getting pregnant. Your doctor may also suggest making certain lifestyle changes, for example, trying to give up smoking if you smoke and if you drink alcohol, don't drink to excess. You may also be advised to lose excess weight.
A balanced diet is important. Antioxidants, such as vitamin C and vitamin E, as well as minerals, such as selenium and zinc, are important for sperm health. You may be advised to take supplements of these.
Depending on the cause of your fertility problems, you may be prescribed medicines to try to improve your chances of conceiving. If you have hypogonadism, it's possible that having gonadotrophin injections will help – these aim to stimulate the production of testosterone.
Medicines that affect your bladder or nervous system may help if you have retrograde ejaculation. However, these medicines can have side-effects, such as dizziness and feeling sick.
Medicines such as sildenafil (Viagra) may be helpful if you have trouble getting an erection.
If an ejaculation disorder is causing your fertility problems, it's possible that stimulating certain nerves can be helpful. Penile electrovibration stimulation affects your spinal cord causing ejaculation and transrectal electroejaculation directly stimulates the nerves that cause you to ejaculate.
These procedures use a probe that is placed on your penis or inserted into your rectum (back passage). Electrodes inside this stimulate your nerves bringing about ejaculation.
If tests show that you have obstructive azoospermia, you may be able to have surgery to remove the blockage. This is often successful at improving fertility. However, if it’s not possible to identify the exact site of the blockage, this type of surgery can’t be carried out.
There are several techniques that can be used to help you conceive. These aim to bring a sperm and an egg close together. The three main methods are:
• intra-uterine insemination
• in vitro fertilisation
• intracytoplasmic sperm injection
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.
Living with male infertility
If you and your partner are having trouble getting pregnant, it can have psychological and emotional effects. Feeling stressed, whether it's caused by your problems conceiving, work or something else, may affect your relationship with your partner. This in turn may have an impact on your libido and how often you have sex, leading to further fertility problems.
You may find it helps to talk to other people – there may be support groups in your area where you can meet couples who are also having treatment for infertility. Alternatively, you may find it helps to talk to someone who isn't closely involved with your situation. Your doctor or clinic may be able to give you details of a specialist fertility counsellor.