Male infertility NEW

What is male infertility?

Male infertility means not being able to father children. The word infertility is used when the female partner in a sexually active couple has not become pregnant after 1 year without the use of contraception. If the cause of the fertility problem is found in the man, this is male infertility. Male infertility is found in approximately half of all childless couples.

Male infertility has several causes:

  • Hormonal problems
  • Genetic disorder or chromosome defects
  • Problems with the testicles and sperm production
  • Difficulties with erection or ejaculation
  • Some medications
  • Trauma
  • Cancer

The tests and treatments vary depending on the cause of infertility.

Diagnosis

Your doctor will do an examination and tests to evaluate the possible cause of male infertility.

Medical history

The medical history is a conversation with your doctor. The doctor will try to determine whether any lifestyle factors could affect your fertility. The interview will focus on different known causes:

  • Thyroid disease
  • Diabetes
  • Erectile dysfunction
  • Occupational or behavioural hazards such as working with pesticides
  • Exposure to extreme heat
  • Stress
  • Current smoking or exposure to smoke during pregnancy
  • The use of cannabis and alcohol, steroids, opioids, or androgens
  • Prior surgery in the genital region
  • Infections
  • Trauma in the genital area
  • Descent of the testicles at birth/ in childhood

Some medications can also affect male fertility:

  • Heart conditions: non selective beta blockers, thiazides, calcium channel blockers, digitalis, antiarrhytmics
  • Antidepressants: tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI)
  • Hormonal therapy: antiandrogens
  • Painkillers and antipyretics: Nonsteroidal anti-inflammatory drugs (NSAIDs
  • Antiepilectics and neuroleptics
  • Antihistamine
  • Antimycotics

Causes and treatment

In most cases of male infertility, either the semen is unable to reach the egg (obstructive) or the semen quality is poor (non-obstructive). The most common causes of male infertility and their treatments are discussed.

Obstructive causes of male infertility

The path of the sperm cells can be obstructed in several places:

  • In the testicles, where sperm cells are produced
  • In the epididymis, the tube that carries sperm from the testicle to the vas deferens
  • In the vas deferens, the tube that transports sperm to the prostate and posterior urethra

The most common causes of obstruction are infections (for example, gonorrhea, chlamydia, prostatitis, tuberculosis), birth defects (congenital disorders), or trauma to the genitalia.

Treatment depends on the amount of obstruction. Semen can be collected by biopsy from the testicle or the epididymis. Surgery on the vas deferens can reestablish the pathway.

Nonobstructive causes of male infertility

Chromosomal abnormalities

Abnormal sexual chromosomes can cause low levels of testosterone. Klinefelter syndrome is the most common sexual chromosome abnormality. In some patients, this condition can cause characteristic features like long limbs, small firm testicles, and female-type hair distribution.

The treatment for this kind of infertility is to collect sperm cells directly from the testicle if possible (TESE). Sperm cells will be functional in less than half of men with Klinefelter syndrome.

Genetic defects

Low levels of sexual hormones affect male fertility. For example, Kallmann syndrome causes low levels of sexual hormones. Men with this syndrome often have low muscle mass, fatigueinfertilityerectile dysfunction, hot flashes, and enlarged breasts.

The treatment is to supplement male hormones using injections that can restore spermatogenesis completely (hormone therapy).

In addition, an increase in general health—for example, losing weight, stopping smoking, adjusting diet, and exercising regularly—may improve fertility.

This information was produced by the European Association of Urology (EAU) Working Group, March 2018.

  • Dr. Maria F.B. Anderson, Roskilde (DK)
  • Dr. Juan Luis Vásquez, Roskilde (DK)
  • Dr. Francesco Esperto, Rome (IT)