A couple may be infertile if they have been trying to get pregnant for a year or more. The correct term is couple not woman. Female infertility is not the most common cause of infertility. Studies show infertility is caused by a woman in only one-third of cases, the man is the cause in one-third, and the cause is unknown in the other third. Infertility affects about 15 percent of couples.
A study that just came out in the journal Human Reproductive Update, suggests that the blame may be shifting to the man more often than it has in the past. The study reviewed 100 other studies on sperm counts in men done over the past 40 years. The conclusion is that sperm counts have fallen by about half, over one percent per year.
The cause is a mystery. Researchers are scrambling to solve this mystery, but it may take years. Part of the problem is that we really don’t know that much about male infertility. Sometimes the cause can be found and treated. In many cases, the cause remains unkown. Treatment may still help, even when the cause remains a mystery.
The most common known cause is failure to make sperm. The next most common cause is something that blocks sperm from making it through the penis during ejaculation, failure of the delivery system. Another cause is medication. Some medications can lower sperm production.
A common cause of sperm production failure is varicoceles. Varicoceles are swollen veins inside the scrotum. They are common in men. They feel like a wormy mass inside the scrotum. They can cause lower sperm production because they block blood drainage from the testicles. This causes body temperature of the testicles to go up. High temperature inhibits sperm production. Spending a lot of time in a hot tub also increases testicle temperature and can be a temporary cause of infertility. Varicoceles are the most common correctable cause of male infertility. They can be removed surgically.
Blockage of sperm delivery can occur if a man has had a vasectomy. In some cases, a vasectomy can be reversed with surgery. Scar tissue from a sexually transmitted disease is another cause of blocked sperm duct and delivery failure. This may also be corrected surgically. After those causes, things get tricky. Here are some less common causes:
- Certain medications used to treat arthritis, depression, cancer, digestive problems, or high blood pressure
- Low levels of testosterone or other hormones needed for sperm production, due to a variety of reasons
- Retrograde ejaculation, which is sperm going into the bladder instead of out the penis, a condition usually caused by surgery, diabetes, spinal nerve damage, or medications
In many cases, male infertility is just a mystery. We do know some possible causes. These causes are hard to prove. However, we can assume that they contribute to many cases of male infertility. These include:
- Smoking cigarettes
- Smoking marijuana
- Being obese
- Drug abuse
- Anabolic steroids
- Reactive oxygen species (ROS)
ROS are tiny molecules in sperm cells and white blood cells. Too much ROS can be harmful to sperm cells. Again, the reasons for this are mysterious. Antioxidants can clean up ROS, and may help increase fertility. Studies show that vitamin E is an effective antioxidant for ROS.
Diagnosing Male Infertility
Doctors look for known causes of infertility by doing a history and physical exam and by checking a sperm sample. In some cases, an ultrasound imaging study may be done by placing an ultrasound probe into the rectum and getting images of the sperm duct system.
A testicular biopsy may be done if a sperm sample shows a very low or absent sperm count. Biopsy may help diagnose a testicular sperm problem. It also may be used to get sperm for assisted reproduction techniques (ART).
Treatments for Male Infertility
Treatments for a known cause of infertility can include changing or stopping certain medications, giving hormone therapy to stimulate sperm production, or surgically removing varicoceles or blockage.
Treatment for possible causes can include vitamin E, and lifestyle changes like losing weight, reducing stress, and avoiding cigarettes and drugs. If all else fails there is ART. There are three ART options:
- Intrauterine insemination (IUI) involves getting sperm from the male partner and placing the sperm sample directly into the female partner’s womb.
- In vitro fertilization (IVF) involves getting a sperm sample from the male partner and an egg from the female partner. The sperm fertilizes the egg in a laboratory and the fertilized egg is placed into the womb.
- When the male partner’s sperm is not available or healthy enough, sperm from a sperm donor can be used for IUI or IVF.
Male infertility is mysterious, but researchers are working to find out why it is getting more common. This research may open the way to better diagnosis and new treatments. For now, odds are still good that treatment can help, even when the cause remains a mystery.