Causes of male infertility

While male infertility is relatively common, many couples go on to conceive despite male infertility issues. Approximately 85% of couples trying to get pregnant conceive in the first year, leaving 15% of couples to sit outside of that relatively normal conception window.

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Typically, when a couple is struggling to conceive, the onus is placed on the woman, her lifestyle, diet and reproductive organs. However, as women’s health, fertility and pregnancy nutritionist Monique Cormack explains, “male infertility or fertility complications are actually solely responsible for up to 30% of infertility issues in Australia”. The good news is that fertility problems in men are normally treatable. We’ve put together an overview of male infertility symptoms, reasons for infertility in men, dealing with male fertility, common causes of male infertility and male fertility treatments.

What is male infertility?

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Male infertility is diagnosed when a couple has been actively trying to conceive for at least a year, and tests reveal that the guy is the underlying source of the problem.

Perhaps surprisingly, male infertility is about as common as female infertility – despite the pressure that’s placed on women and their ticking biological clocks… In fact, male infertility is the root cause of roughly a third of all infertility cases, while female infertility is also responsible for a third of infertility cases. The remaining third of infertility cases are put down to either ‘unidentified infertility’ or may be a combination of factors between both partners.

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What are the common causes of male infertility?

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The most common causes of male infertility are…

• Obstructions or blockages to the passage of sperm
• Problems with sperm (such as low sperm count)
• Functional problems (like impotence)
• Hormonal issues

Blockages causing infertility in guys…

Sperm are made in the testicles, then they spend on average about a week passing through a series of small tubes. When a guy ejaculates, muscular contractions force the semen into the urethra and out of the penis. Blockages or absences of tubes are the most common cause of male infertility, responsible for around one in three cases of male infertility issues. Blockages or absences of tubes may be the result of a vasectomy or injury.

Sperm causing infertility in guys…

Problems with sperm numbers, quality or motility are often tied to genetic factors. Tiny fragments of the male chromosome may be missing in some men with sperm problems. This may cause:

• No sperm in the semen – often the result of a blockage of the tubes or the testicles not producing sperm.
• Low sperm count.
• Abnormal shape – a healthy sperm is shaped like a tadpole, but sometimes sperm is shaped abnormally and may have trouble penetrating the surface of the woman’s egg.
• Poor motility – a healthy sperm has a lashing tail which helps it to swim through the woman’s reproductive system. Sperm with poor motility may be an inefficient swimmer.

Functional problems causing infertility in guys…

Functional problems that can cause or contribute to male infertility include:

• Impotence – the inability to get or maintain an erection.
• Ejaculation problems – sometimes men experience ‘retrograde’, when semen travels to the guy’s bladder instead of through his penis, or premature ejaculation.
• Issues with the testicles – caused by injury, infection or chemotherapy.
• Prostatectomy – side effects of the surgical removal of the prostate gland.
• Antibodies – when a guy’s immune system makes antibodies that obstruct his sperm’s ability to latch onto his partner’s egg.

From a dietary and lifestyle perspective, Monique explains that factors such as consuming too many fats, processed meat and sugary soft drinks, alcohol and smoking consumption, low intake of vegetables, fruit and fibre and nutrient deficiencies can reduce fertility in men.

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How is male infertility diagnosed?

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If a couple has been having regular unprotected sex for an entire year and still aren’t pregnant, infertility will likely be diagnosed. However, to get to the root cause of the infertility problem – as a pathway to landing on an appropriate fertility treatment, a doctor or fertility specialist will run a series of tests.

Here’s what to expect with male infertility tests:

• Physical examination – including medical history
• Semen analysis
• Blood tests
• Testicular biopsy – a fine needle and microscope are used to check the network of tubes within the testicles to see if they contain any sperm
• Ultrasound – to look at the reproductive organs, specifically the prostate gland

Who’s at risk of male infertility?

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While any man can be affected by infertility, even if he’s already a biological dad, the guys most at risk of male infertility are men who:

• Smoke cigarettes
• Use marijuana, drink excessive amounts of alcohol or take other drugs
• Have an anatomical problem like varicocele, that affects the reproductive system
• Have a hormonal imbalance, such as a thyroid problem
• Take testosterone therapy or anabolic steroids
• Have a chronic disease, are undergoing radiation or chemotherapy for cancer treatments, are taking medications to treat prostate cancer or who have immune or auto-immune issues
• Overweight or obese
• Over the age of 40 (yep, guys can also get ‘too old’ for having babies too…)
• Are regularly exposed to environmental toxins
• Are regularly exposed to heat around the testicles (spa, sauna, jacuzzi, bike riding).

“Generally speaking, a standard “Western diet” that is higher in refined grains, sugar-sweetened drinks, processed foods and red meats has been associated with an increased risk of male fertility issues,” says Monique. “It’s easy to fall into a rut of convenient, tasty foods and a drink or three in the evening, but these habits can negatively impact fertility.”

How to prevent male infertility?

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Monique stresses that nutrition and lifestyle are “critical ways in which men can take control and ensure their sperm are as healthy as possible”. She says that a Mediterranean diet has been proven to improve sperm health and quality, as well as supporting overall health in both men and women.

Here is a list of the vitamins Monique recommends taking for healthy male fertility and babymaking:

• Zinc
• Folate
• Selenium
• Omega-3 fatty acids
• Ubiquinone/Coenzyme Q10

To help improve your fertility, you should avoid…

• Cigarette and marijuana smoking
• Excessive alcohol consumption
• Recreational drugs
• Sexually transmitted infections
• Heat stress from saunas, jacuzzies or even tight-fitting underwear
• Anabolic steroids (for body-building or sporting purposes).

What are the possible treatments for male infertility?

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While no treatments can improve the quality of a man’s sperm, depending on the underlying cause of male infertility, various techniques and treatments can increase the odds of conception using his existing sperm.

The good news is that many men have sufficient sperm to fertilise their partner’s eggs in a test tube, even if they aren’t unable to do so during sex. Normally, the couple can be helped with assisted reproductive technologies (ART), such as In Vitro Fertilisation (IVF).

The ART techniques available to infertile men include:

• Surgery
• Hormone therapy
• Artificial insemination
• In-vitro fertilisation (IVF)
• Intracytoplasmic sperm injection (ICSI)

If the underlying cause of male infertility is anatomical (such as varicocele), surgery is often the best option. Whereas, medication is often used to treat other health problems, like a thyroid disorder or uncontrolled diabetes. ART (such as IVF) can be used when the underlying cause of a man’s infertility is unknown. And if a guy’s sperm is not able to be used for conception, donor sperm or donor embryo is another option.

Can male infertility be cured?

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Because male infertility is so complex and can be the result of multiple underlying factors, there’s no one answer as to whether a couple struggling to get pregnant as a result of male infertility will go on to conceive.

However, Monique says, “Many, many factors that affect male fertility CAN be treated. When it comes to things like poor sperm motility or morphology, we can implement nutrition strategies to improve these factors and help conception happen!”

As long as a man produces some amount of sperm, conception is possible. In fact, some couples dealing with low sperm counts or abnormal sperm are still able to conceive without any additional interventions. However, fertility treatment is always an option to explore; if you’ve been having unprotected sex for a year (or for six months if the woman in the couple is over 35), and still haven’t conceived, it’s worth consulting your doctor.

“Male fertility is often overlooked or left until the last minute”, Monique explains. Understanding both the role male fertility plays in conception and the dietary and lifestyle changes that can be made to improve male fertility are important – and can ultimately lead you to your desired conception result sooner.

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