Male infertility

About male infertility

It's thought that one in seven couples in the UK have trouble conceiving. However, it's important to remember that more than eight in 10 couples will conceive within one year of having regular, unprotected sex, and more than nine in 10 couples will do so within two years.

Infertility is defined as not getting pregnant within two years of having frequent, unprotected sex. You may have primary infertility – this means you and your partner have never previously conceived a pregnancy together – or secondary, which is when you have.

In about one in 10 couples with fertility problems, both partners have a condition that affects their ability to have a baby.

Symptoms of male infertility

There aren't any specific symptoms of infertility, but if the problem is caused by a particular medical condition, you may have symptoms as a result of that.

Causes of male infertility

It may not be possible to find a cause for your infertility – this is true for about a quarter of couples who have problems conceiving.

Sperm disorders

The most common reason for male infertility is a problem with your sperm. This is the cause for three-quarters of men who have fertility problems. It may be that:

  • you don't have enough sperm in your semen
  • your sperm don't move as fast as they need to
  • your sperm are the wrong shape

Usually these three features occur together.

About 10 to 15 men in every 100 who have problems with fertility have no sperm at all in their semen (azoospermia). There are many reasons why this may be, but the most common cause is a condition called obstructive azoospermia. This is when you don't have any sperm in your semen because there is a blockage in both of your seminal ducts (the tubes that carry sperm from your testicles to your penis). The blockage may be in the epididymis, vas deferens or ejaculatory duct, which are all part of your seminal ducts. The obstruction may be:

  • congenital – this means you were born with it and often it isn't possible to find a cause
  • acquired – this means you developed the condition as a result of an infection or surgery in the area

Hypogonadism

Your fertility problems may be a result of a condition known as hypogonadism – this may be congenital or acquired. If you have hypogonadism, it means that you don't produce enough or any of the hormone testosterone. Congenital causes include being born with one or no testicles, or conditions that affect your hypothalamus and pituitary gland, which are important for hormone production. These conditions are often the result of a genetic problem. Acquired hypogonadism may occur after an illness or accident, or as a result taking with certain medicines.

Testosterone has many functions in your body, but in particular it's essential for healthy development of the male genital organs and production of sperm. You also need testosterone to get an erection and to maintain your sex drive (libido).

Ejaculation disorders

For some men, fertility problems may be caused by a problem with ejaculation. Some of these are explained here.

  • Anejaculation is when you don't produce any semen.
  • If you have anorgasmia, this means you don't reach an orgasm or ejaculate.
  • You may need more stimulation than usual to ejaculate – this is called delayed ejaculation.
  • Retrograde ejaculation means the semen you produce moves backwards into your bladder instead of being ejaculated outside your body when you orgasm.

Factors affecting fertility

There are a number of other factors that can affect your fertility, including:

  • smoking, also if your mother smoked during pregnancy
  • drinking alcohol excessively
  • taking illegal drugs, such as cannabis and cocaine
  • using anabolic steroids
  • chemotherapy or radiotherapy
  • being overweight or obese
  • the temperature of your scrotum being too high – this may be a result of being exposed to heat as part of your job, wearing underwear that is too tight, or often using a laptop computer on your lap
  • certain jobs – for example, if you're exposed to some chemicals found in pesticides or solvents
  • some medicines, such as sulfasalazine or cimetidine
  • stress

It's not known whether a man's fertility declines as he gets older.

Diagnosis of male infertility

See your GP if you're concerned about your fertility. If possible, it's a good idea for you and your partner to go together. Your GP is likely to ask you for how long you have been trying to have a baby and whether you have had any problems having sex. He or she may ask you about your lifestyle and medical history including whether:

  • you have had children with a previous partner
  • you have ever had any sexually transmitted infections (STIs), serious long-term diseases or other conditions that can affect fertility
  • you're taking any medicines

Your GP may also need to examine you.

If you have not already been doing so, your GP is likely to recommend that you have unprotected sex two to three times a week for a year before carrying out any tests. After this time, or sooner if you or your partner have a condition that means you're less likely to conceive, there are a number of tests that he or she may do.

Your GP may suggest a test to check if you have been infected with chlamydia. He or she is also likely to ask you to provide a sample of semen so it can be tested for a number of things, including how many sperm it contains and how fast they are able to move. If this shows any problems, you will need to have the test repeated after three months. This may be done sooner depending on the findings of the first test. If the second test confirms that there is a problem with your sperm, your GP may refer you to a fertility specialist for further tests to see what is causing this.

Your fertility specialist is likely to examine you if you have a sperm problem. He or she may also recommend you have further tests, which may include hormone checks, chromosome tests and a screening test for cystic fibrosis. For some men, a fertility specialist may recommend a special test to check for damage to the DNA of their sperm.

Treatment for male infertility

Your treatment will depend on what is causing your fertility problems.

Self-help

Having sex two to three times a week is thought to maximise the chance of your partner getting pregnant. Your GP may also suggest making certain lifestyle changes, for example, trying to give up if you smoke and not drinking more than three to four units of alcohol a day. You may also be advised to lose excess weight. A balanced diet is important. Antioxidants, such as vitamin C and vitamin E, as well as minerals, such as selenium and zinc, are important for sperm health. You may be advised to take supplements of these.

Medicines

Depending on the cause of your fertility problems, you may be prescribed medicines to try to improve your chances of conceiving. If you have hypogonadism, it's possible that having gonadotrophin injections will help – these aim to stimulate the production of testosterone. Medicines that affect your bladder or nervous system may help if you have retrograde ejaculation. However, these medicines can have side-effects, such as dizziness and feeling sick.

Medicines such as sildenafil (Viagra) may be helpful if you have trouble getting an erection.

Non-surgical treatments

If an ejaculation disorder is causing your fertility problems, it's possible that stimulating certain nerves can be helpful. Penile electrovibration stimulation affects your spinal cord causing ejaculation and transrectal electroejaculation directly stimulates the nerves that cause you to ejaculate. These procedures use a probe that is placed on your penis or inserted into your rectum (back passage). Electrodes inside this stimulate your nerves bringing about ejaculation.

Surgery

If tests show that you have obstructive azoospermia, you may be able to have surgery to remove the blockage. This is often successful at improving fertility. However, if it’s not possible to identify the exact site of the blockage, this type of surgery can’t be carried out.

Assisted conception

There are several techniques that can be used to help you conceive. These aim to bring a sperm and an egg close together. The three main methods are:

  • intra-uterine insemination
  • in vitro fertilisation
  • intracytoplasmic sperm injection

For more information about these procedures, please see our related topics.

Living with male infertility

If you and your partner are having trouble getting pregnant, it can have psychological and emotional effects. Feeling stressed, whether it's caused by your problems conceiving, work or something else, may affect your relationship with your partner. This in turn may have an impact on your libido and how often you have sex, leading to further fertility problems.

You may find it helps to talk to other people – there are support groups where you can meet couples who are also having treatment for infertility. Alternatively, you may find it helps to talk to someone who isn't closely involved with your situation. Your doctor or clinic can give you details of a specialist fertility counsellor.

Can complementary therapy help male infertility?

Answer

There is no evidence to suggest that any complementary therapy can help infertility. However, some research has shown that certain herbal remedies may improve your libido and ability to get an erection.

Explanation

At the moment, it's not known whether or not complementary therapy is helpful in treating infertility. Further research is needed before any particular therapy can be recommended.

A small amount of research has been done to look at the effectiveness of certain herbal remedies in improving male erectile dysfunction. There is some evidence to suggest that yohimbine – a substance found in the bark of an African tree – may help your ability to get an erection.

A review of research has suggested that men with erectile dysfunction who took the herbal remedy Korean red ginseng had better sexual function afterwards. However, more research is needed into both yohimbine and Korean red ginseng before it's possible to say whether they have any effect beyond that of a dummy treatment (placebo). This is when you believe something has helped, but actually it hasn't had any effect at all. You may find herbal remedies helpful, but it’s important to remember that natural doesn’t mean harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Speak to your GP before trying any complementary therapy and don’t start taking any herbal remedies without speaking to your GP or pharmacist first.

Will chemotherapy affect my fertility?

Answer

It's possible that some chemotherapy medicines will reduce your fertility. However, this may only be temporary.

Explanation

Not all chemotherapy medicines will reduce your fertility, but some may mean you produce fewer sperm or they may damage your sperm. Chemotherapy may also reduce your ability to get an erection because it can affect the nerves that supply this area. These problems will probably go once you finish having chemotherapy, although it may take several months.

It's important to use contraception while you're having chemotherapy as the medicines may harm a baby that you conceive.

Your fertility may be only temporarily affected by chemotherapy medicines, although it may take several months or years to return to normal. However, it's also possible that you won't be able to have children in the future. It's important to speak to your doctor before having any treatment that may affect your fertility. He or she will be able to give you advice about storing your sperm before you start treatment.

Is it true that having mumps as a child can affect your fertility?

Answer

No, if you have mumps during childhood, it won't affect your fertility. There is a small risk that if you get mumps as an adolescent or adult and it causes inflammation of your testicles, you may have a slightly increased risk of fertility problems.

Explanation

If you get mumps as an adult, it's possible that this will lead to inflammation of one or both of your testicles (orchitis) and maybe also in your epididymis (epididymo-orchitis). Up to one in four men who have mumps after puberty will develop this condition and up to a third of these men will have swelling on both sides.

It's possible that epididymo-orchitis can cause problems with sperm production by your testicles. If you're concerned about your fertility following mumps infection, see your GP who may suggest a test to check that your sperm is healthy.