What is male infertility?

Male infertility usually refers to a situation in which the cause of a couple’s infertility is a problem with spermatogenesis or the movement of sperm through the male reproductive system.

How common is male infertility?

We don’t always know the reason why some couples are infertile1

Most experts believe (based on their own experience and limited scientific data):

  • For 1 in 5 infertile couples (those who do not conceive a pregnancy after 12 months of trying), male infertility is the cause
  • For 1 in 3 infertile couples, female infertility (due to problems with the menstrual cycle, ovulation or reproductive system) is the cause
  • For about 1 in 3 infertile couples, male and female factors probably contribute

If you’re seeking help to conceive, both partners should have their fertility investigated from the beginning because male factors contribute to many cases of couples’ infertility2,3,4.

What causes male infertility?

Male infertility can be caused by problems that affect sperm production or how the sperm move.

Problems with sperm include:

  • Azoospermia (when the semen doesn’t contain any sperm)
  • Oligospermia (low sperm count)
  • Abnormal shape (which affects the sperm’s ability to fertilise the egg)
  • Poor motility (which affects the sperm’s ability to swim)

These can be caused by:

  • Genetic conditions like Klinefelter syndrome (47 XXY)
  • Non-genetic conditions like varicocele, testicular inflammation or injury
  • Severe illness or infection
  • Some medications
  • Undescended testes
  • Abnormal hormonal function (due to genetics, infection, a cancerous or non-cancerous tumour, or a consequence of surgery)
  • Testosterone therapy
  • Abuse of anabolic steroids
  • Obesity
  • Age
  • Alcohol use
  • Smoking
  • Exposure to high temperatures (like saunas or occupational exposures)

Transport of sperm can be prevented by abnormalities in development that result in some parts of the male reproductive tract not developing at all, such as in men with congenital bilateral absence of the vas deferens. Other men may have blockages in their reproductive tract because of scarring or accidental injury during surgery or for unknown reasons.

Ejaculation problems and erectile dysfunction can be causes of male infertility.

Some types of cancer treatment can affect men’s fertility. Collection and storage of a semen sample are possible before such treatments, so healthy sperm can be used for in vitro fertilisation (IVF).

How is male infertility diagnosed?

To diagnose male infertility a semen sample will be analysed to look at the number of sperm, their size and shape, and their movement. A blood sample may be taken to measure hormone levels.

It may be necessary to test for infections or to look at the testes using an ultrasound scan. In some instances, a biopsy of the testes might be required.

Investigation of male fertility should occur at the beginning of investigations into a couple’s infertility, at the same time as investigations into the female partner’s fertility2, 4. Without a proper assessment of a male partner’s fertility, there is a risk of unnecessary investigations and treatment of female partners5.

What your partner might be feeling

When it comes to fertility testing, your partner might feel embarrassed, uncomfortable, and anxious about the process. They might feel like it questions their virility, manhood, or masculinity.

The emotional response to a diagnosis of male factor infertility varies from person to person. Men can experience depression and psychological distress if they’re unable to have children. If male infertility is responsible for a couple being unable to have children, the male partner may feel a sense of failure, and a greater sense of loss, stigma, and low self-esteem than if a female factor is a cause6.

These feelings might be expressed as irritability, anger, withdrawal, or sadness. They might find it hard to communicate what they’re going through and feel isolated or alone. Seeking support through your fertility specialist, therapist, support groups, as well as being open with friends and family may help.

Couples who experience infertility may experience a strengthening of their relationship, perhaps due to their shared experience of difficulties conceiving. Some men’s concern for their partner’s wellbeing may enhance their relationships. Men who do not hide their infertility, who express their feelings and seek advice, describe the greater strengthening of their relationship.

Support that’s tailored to the needs of both partners, that provides emotional support, information about treatment, and develops adaptive coping strategies7 should be provided to all couples8.

What you might be feeling

Regardless of the underlying problem, a couple’s infertility affects both of you and it can impact your relationship.

Some women whose partners are infertile may be distressed by their partner’s emotional response or what seems to be resistance to investigations and treatment. Whether it’s a shoulder to lean on or some time alone — talk to your partner about what they need in terms of support and when.

Sexual function and satisfaction can decrease in men and women who experience infertility, but women tend to be affected more than men in this respect2.

It’s important to acknowledge the feelings you have about infertility and take care of your wellbeing too. Chat to your GP or a counsellor who will offer support and strategies for navigating the situation.

What you can do about infertility

Treatment for male infertility depends on the cause10 and your health care team will help you determine the next steps for starting or growing your family. Lifestyle changes, treatment of other medical conditions or surgery may be required. If these are unsuccessful, it may be possible to use assisted reproduction technology (ART) to help you to conceive.

It can be helpful to get on the same page with your partner about fertility treatments with an honest conversation about the physical, emotional, and financial factors involved. When discussing infertility, choose a time when you or your partner won’t feel particularly vulnerable, stressed, or uncomfortable. This could be during a walk or a drive, where you’re shoulder-to-shoulder rather than face-to-face. Avoid assigning blame and approach infertility as a team.

References

[1] Barratt et al., 2017. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance—challenges and future research opportunities. Human Reproduction Update

[2] Schlegel et al., 2021. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I. Journal of Urology

[3] Schlegel et al., 2021. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline PART II. Journal of Urology

[4] Minhas et al., 2021. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. European Urology

[5] Turner et al., 2020. Male Infertility is a Women’s Health Issue—Research and Clinical Evaluation of Male Infertility Is Needed. Cells

[6] Luk & Loke, 2015. The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review. Journal of Sex & Marital Therapy

[7] Szatmári et al., 2021. Adaptive coping strategies in male infertility, paramedical counselling as a way of support. Journal of Reproductive and Infant Psychology

[8] Gameiro et al., 2015. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction—a guide for fertility staff. Human Reproduction

[9] Taghipour et al., 2020. Exploring Iranian women’s perceptions and experiences of their spouses’ behaviour towards male factor infertility: a qualitative study. Current Women’s Health Reviews

[10] Jungwirth et al., 2012. European Association of Urology Guidelines on Male Infertility: The 2012 Update. European Urology

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