About 15 percent of couples can’t get pregnant with regular, unprotected sex. That equals to nearly 13 out of 100 couples worldwide. There are many factors that cause male infertility and female infertility in both men and women. In about a third of the infertility cases, the problem is with the man. Unlike female infertility, male infertility is not always obvious. Contrary to the popular belief, the ability to produce sperm alone does not guarantee fertility success.
What is Male Infertility?
Male infertility is defined by any health issue in a man that lowers the chances of his female partner getting pregnant. Male infertility is diagnosed only after medical assessment and fertility testing have been carried out.
Male fertility depends on the ability to produce viable, mobile sperm that is able to travel through the female cervix into the uterus to the fallopian tubes. There, the sperm and a mature egg meet and combine together to produce a zygote. This is how natural conception works. The male reproductive system is complex and works only when the genes, hormone levels and environmental factors are right.
How common is Male Infertility?
Male infertility contributes to around 30 percent of all infertility cases. One in five couples is affected by male factor infertility.
What are the Signs of Male Infertility?
In most cases, there are no obvious signs of infertility. Men who struggle with infertility may have regular, normal intercourse, erections and ejaculation. Even the quantity and appearance of the ejaculated semen may look normal to the naked eye. Fertility tests are needed to diagnose infertility. Sometimes there are signs that may suggest male infertility is the problem. These include:
- Changes in sexual desire
- Issues with ejaculation
- Problems maintaining erection
- Testicle pain or swelling
- Ejaculation problems
- Small, firm testicles
What is the Cause of Male Infertility?
Some of the most common causes of male infertility include:
- Sperm production problems
- Sperm transport problems
- Ejaculation dysfunction
- Hormonal problems
- Sperm antibodies
- Cancer treatment
- Unknown cause
Male infertility usually occurs due to either sperm production or sperm transport problems. The cause for infertility can be identified through fertility testing.
About two-thirds of infertile men struggle with low sperm count or low sperm motility. This means that the sperm produced is either in insufficient quantities and/or the sperm that are made do not move properly. Sperm mobility problems are present in about one in five infertile men. These problems usually occur due to blockages (obstructions) in the tubes. As a result, the sperm is not distributed through the reproductive system, causing a complete lack of sperm in the ejaculated semen.
Other less common causes of infertility include: infertility issues arising from the sperm not being able to meet the egg; low levels of hormones produced in the pituitary gland that affect the testes; and sperm antibodies that attack the viable sperm cells. In most men, sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.
In short, male infertility usually occurs because of sperm that are abnormal or insufficient, or due to ejaculation problems.
Is Male Infertility Genetic?
Some chromosomal and genetic abnormalities can cause abnormal sperm production or blockages in the reproductive tract that prevent sperm from moving. These include:
- Klinefelter’s syndrome
- Y chromosome deletions
- Other genetic problems, such as Down syndrome.
Infertility due to single gene mutations are less common. Mutations in the cystic fibrosis gene can cause obstruction (blockage) in the sperm delivery system.
How to Check Male Fertility?
- Hormone Testing
Hormone testing is an efficient way of identifying the cause male infertility that is related to sperm production. One should keep in mind that normal hormone levels do not necessarily mean absence of a fertility problem. The following hormones get checked during fertility testing:
- FSH (follicle stimulating hormone) is a hormone that stimulates sperm production. Normal levels should be between 5 to 10 mlU/mL. Raised levels of FSH may be a sign of malfunction in the testis. Complete absence of FSH in men may lead to lack of sperm (azoospermia). Lower levels of FSH can cause limited sperm production (oligozoospermia).
- Testosterone is another hormone that plays an important role in sperm production. The normal range is 300 to 1,111 nanograms per deciliter. Testosterone levels that are below the normal range can cause hypogonadism. Some signs or symptoms of low testosterone are erectile dysfunction or decreased libido.
- Semen Analysis
This is another fertility test that measures sperm count, motility and shape. A semen analysis provides information about the quality and quantity of sperm. According to the World Health Organization (WHO), the following range indicates normal sperm results:
| Ejaculate volume | 1.5–7.6 mL |
| Sperm concentration | 15–259 million per mL |
| Total motility | 40–81 percent |
| Morphology | 4–14 percent |
Sperm concentration refers to the number of sperm that are present per milliliter in the produced semen. Motility determines if the sperm are moving properly. Morphology measures the shape of the produced sperm.
In IVF Cyprus treatments, infectious disease screening is also required. This includes HIV and Hepatitis B and C testing. Additional testing such as physical examination or genetic testing may be required.
Can Alcohol cause Male Infertility?
Excessive alcohol decreases testosterone levels and may lead to shrinking of the testicles. This can in turn lead to reduced fertility and even to erection problems. Alcohol causes testosterone to be eliminated faster from the blood, and raise the levels of estrogen.
Alcohol can also reduce libido and sperm production. Decreased quantity and quality of sperm is a common cause of infertility in men. The more alcohol you drink, the worse it will be for your fertility. If you stop or reduce drinking alcohol, these effects can be quickly reversed. Avoiding alcohol while trying to conceive can improve the chances of pregnancy success.
Does Stress Affect Male Fertility?
A study showed that men who experienced two or more stressful life events in the past year had decreased sperm quality, compared with men who did not experience any significant stressful life event. Also, men who faced high demand in the workplace had lower levels of testosterone, which could lead to fertility problems.
Other Male Infertility Factors
A number of other factors can affect male fertility. These include:
- smoking
- taking drugs such as marijuana and cocaine
- using anabolic steroids
- chemotherapy
- being overweight or obese
- having a job that exposes you to certain chemicals
- some medicines – for example, sulfasalazine (which is used to treat rheumatoid arthritis and inflammatory bowel disease)
- stress
- age (although not as much as it affects women).
Is Male Infertility Curable?
Treatments for male infertility are based on the medical condition that led to the fertility problems in first place. Treatments include:
- surgery to correct or repair anatomic abnormalities or damage to the reproductive organs
- hormonal therapy to establish healthy hormone levels
- IVF (in vitro fertilization)
- sperm donation
Medication can be used to treat fertility issues that are caused by hormone imbalance or erection problems. Infections that interfere with male fertility can be treated with antibiotics. Surgery can be effective for sperm transportation problems to unblock the tubes that deliver sperm.
Surgery can also help with medical conditions such as varicocele (enlarged veins in the scrotum). Assisted reproductive technologies (ART), such as in vitro fertilization (IVF), can be effective if other treatments don’t work. Sperm donation in Cyprus is also an option for severe male infertility or when the baby is at risk of receiving a genetic condition from the parent.
IVF Treatment in Cyprus for Low Sperm Count
During IVF in Cyprus, sperm are collected either from ejaculated semen or via surgical sperm retrieval methods. For men who struggle with normal sperm production, micro TESE (microdissection testicular sperm extraction) can be applied to collect viable sperm for fertilization. Micro TESE in Cyprus is a minimally invasive procedure that involves collecting sperm from the seminiferous tubules (a reservoir of sperm) through a very small incision in the scrotum.
Collected sperm is processed and sorted out in our euroCARE IVF lab. Single sperm cells are then injected through a tiny needle into the collected eggs. This procedure is called Intracytoplasmic sperm injection (ICSI). The fertilized egg (embryo) is transferred on day three or day five after egg retrieval. ICSI in Cyprus can be performed when the male partner struggles to produce sufficient amount of sperm or the produced sperm is abnormal. This advanced technique is so successful that we use it in all our IVF treatments to increase the likelihood of fertilization.
How to Increase Male Fertility?
- Do not consume alcohol or cut down your intake.
- Quit smoking. Smoking can decrease fertility and can put a newborn baby’s health at risk
- Get tested for STIs (sexually transmitted infections) if there is any reason you think you are at risk of having one
- Lose weight if you have a high body mass index (BMI over 25)
- Keep testicles cool (slightly below the body temperature)
- Eat five portions a day of fruit and vegetables, carbohydrates such as whole grains (quinoa, oats, brown rice, etc) and wholemeal bread and pasta, and lean meat, fish, legumes and beans for protein
- Exercise for at least 20-30 minutes three times a week
- Talk to your doctor if you have sickle cell disease or thalassaemia
- Reduce stress. Stress can decrease the libido and sperm production.
Best supplements for men
Here are some of the vitamin supplements that boost fertility in men:
- Vitamin C
- Vitamin D
- Zinc
- Coenzyme Q10
Treatment for Male Infertility at euroCARE IVF
Infertility is a common problem that affects many men around the world. If you are one of them, consider talking to our fertility doctor. Try to focus on improving your general health. Contact our IVF specialists to talk through the different treatment options to address your fertility problem effectively.Resources:
Journal Fertility and Sterility
World Health Organization (WHO)
https://www.bupa.co.uk/health-information/mens-health/male-infertility