Male Infertility: Causes, Symptoms, and Treatment
Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. About one-third of infertility cases include factors exclusively related to male reproductive function.
If you’ve experienced infertility, you’re not alone: about 9% of men and 11% of women in the U.S. have faced fertility challenges. And while these challenges may feel overwhelming, they do not necessarily mean that you won’t be able to start a family one day — there are a variety of fertility treatment options for both men and women to support your family building journey.
Below, we explain more about male infertility, including causes, symptoms, and treatment options that can help you build or add to your family.
What causes male infertility?
Male infertility most often stems from issues with sperm production. In some cases, it may be a problem with the quality of your sperm, like how fast or how well your sperm move. In other instances, it’s a matter of sperm quantity: you may not be able to produce any sperm, or you may have a low sperm count (the threshold is typically a sperm count under 15 million sperm per milliliter of semen.)
Issues with sperm production or function may be caused by the following:
- Hormone, pituitary gland, or immune system problems
- Genetic conditions like cystic fibrosis
- Hemochromatosis, a condition in which you have an excess of iron in your system
Lifestyle and environmental factors can also play a role: heavy smoking (20 or more cigarettes per day), consistent heavy drinking or binge drinking (for men, five or more drinks in a two-hour timeframe), drug use, and exposure to toxins like endocrine disruptors contained in plastics and pesticides have been linked to male infertility.
Beyond issues with sperm production, anything that blocks a reproductive organ can interfere with the flow of semen, including inflammation from a sexually transmitted infection, scar tissue from surgery, or swollen veins in any of your reproductive organs. Additional factors in male infertility include erectile dysfunction, premature ejaculation, liver or kidney disease, and treatment for seizure disorders.
Risk factors for male infertility
You may have a greater chance of experiencing fertility issues if you have had any of the following:
- Inflammation of your prostate or genital infections
- Injury to or twisting of your testicles
- Hernia repair
- Undescended testicles
- Early or late puberty
Certain prescription medications may also increase your risk of infertility, including:
- 5-alpha-reductase inhibitors, a medication class used to treat prostate enlargement and hair loss, which includes finasteride (Propecia®) and dutasteride (Avodart®)
- Alpha blockers like silodosin (Rapaflo®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), and doxazosin (Cardura®), which are used to treat prostate enlargement
- Some selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, including sertraline (Zoloft®) and paroxetine (Paxil®)
- Spironolactone, which may be used to treat high blood pressure or acne
- Cimetidine, which is used to treat acid reflux and gastroesophageal reflux disease (GERD)
Diagnosing male infertility
If you and your partner are unable to conceive after trying for at least a year, one or both of you may be experiencing infertility. If you have experienced any of the following symptoms, you may wish to consult with your doctor about a potential diagnosis of male infertility:
- Erectile dysfunction
- Problems with ejaculation, including delayed ejaculation
- Low sex drive
- Pain or swelling in your genital area
If you have previously had surgery in your genital area, you should also consult with a doctor about potential infertility issues.
To evaluate you for an infertility diagnosis, your doctor will first ask questions about your medical history, including your sexual history and any other factors that may affect your reproductive health and fertility. They may also do a physical exam to check your genitals for any abnormalities.
The next step is typically a semen test, sometimes called a sperm count. Your doctor will ask you for a sample of semen. During their evaluation, they will look at how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail.
Your doctor may recommend additional tests, including blood tests to evaluate your hormone levels and to rule out other health conditions, and genital ultrasounds to identify potential reproductive health issues.
Treatment options for male infertility
Thanks to the medical community’s advances in fertility treatment and technology, infertility issues do not mean that you won’t be able to build a family. There are a range of treatment options that can help increase your chances of conception. Your doctor will make recommendations for the best course of treatment based on the underlying cause of your fertility issues.
Oral medications such as the following are the firstline treatment for most cases of male infertility.
- Clomid® is an oral medication that can increase testosterone and sperm production as well as improve sperm motility.
- Letrozole (Femara®) is an oral medication that can improve sperm count and motility. A non-steroidal aromatase inhibitor, it functions by decreasing estrogen production.
- Anastrozole (Arimidex®) is another oral non-steroidal aromatase inhibitor used to increase sperm count and improve sperm motility. It can also help restore the testosterone-estrogen balance for some men experiencing infertility.
Additionally, tadalafil (Cialis®, Adcirca®), vardenafil (Levitra®, Staxyn®), and sildenafil (Viagra®, Revatio®) may be used to treat erectile dysfunction, a factor in male infertility.
An evaluation is typically scheduled after 3-6 months of treatment. If oral medications haven’t been effective by this point, a provider may recommend injectable gonadotropin therapy or assisted reproductive technology (ART) treatments.
There are two types of hormones used in injectable gonadotropin therapy: human chorionic gonadotropin (hCG) and follicle stimulating hormone/luteinizing hormone (FSH/LH).
hCG treatment triggers the testes to produce testosterone, which leads to production of new sperm. Common hCG medications used to treat male infertility include Pregnyl®, Novarel®, and Ovidrel®.
FSH/LH treatment triggers production of new sperm. Common FSH/LH medications used to treat male infertility include Gonal-f®, Follistim®, and Menopur®.
hCG treatment can be used alone to stimulate sperm production, but FSH/LH treatment must be used in tandem with hCG treatment. If hCG treatment is not successful after six months, FSH/LH treatment may be added to a medication protocol.
While injectable therapies are effective, they take time to work. The length of treatment ranges from six months to 1-2+ years. Keep in mind that once new sperm is produced, it takes an additional 3-4 months before it is available.
Assisted reproductive technology treatments
There are several fertility treatment options that can increase your chances of conceiving a child, including in vitro fertilization (IVF) using a technique called intracytoplasmic sperm injection (ICSI) and different forms of artificial insemination like intrauterine insemination (IUI).
In intracytoplasmic sperm injection (ICSI) a single sperm can be injected directly into an egg. This procedure is often incorporated into an IVF cycle for many couples affected by male infertility. IVF is a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. Women trying to conceive may undergo IVF treatment if their partner is experiencing male infertility to increase their chances of conceiving. ICSI can be the fertilization method used in IVF.
In IUI, sperm that have been washed and concentrated are placed directly into your partner’s uterus around the time that they are ovulating, helping your sperm reach an egg more easily.
Since lifestyle habits like heavy smoking or alcohol use can affect sperm production, you may be able to increase your sperm count with healthy choices like exercising regularly and abstaining from cigarettes, alcohol, and drugs.
A fertility pharmacy partner you can rely on
At Alto, we understand that there are many paths to parenthood, and that each individual or couple’s needs are different. Our team of pharmacists is experienced in male infertility treatment options, and we’ll be here at every step of the way if fertility medications become part of your plan.
Reach out through in-app messaging or by phone at 1-800-874-5881.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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Editor’s Note: This post was originally published in April 2022 and has been updated for accuracy and completeness.