One in seven couples experience difficulty conceiving – about 3.5 million people in the UK. In a significant number of such cases the infertility is related to the man. Around one in three cases of infertility is due to the man alone, while 50% of infertility cases involve the man in some regard.There are many potential causes of male infertility, and in many cases the precise cause is unexplained. It is important to understand what is meant by ‘infertility’ and the factors that might be related to it.
Infertility is the failure of a couple to conceive despite having regular, unprotected sex for at least one year. Generally after a year of regular, unprotected sex, 80% of couples will be pregnant. Of the remainder, half should conceive over a second year. For the remaining 10% of couples, the chance of conceiving over the next four years is about 50/50. Even after years of unsuccessful attempts, conception may still occur.
“Your doctor will be happy to talk through any difficulties you may have concerning fertility,” says Doctor Minal Bakhai. “It is best for both parties to see their GP together.”
Complete male infertility – when the man is incapable of fertilization – is very rare. Most men who experience difficulties conceiving are almost certainly ‘subfertile’: for various potential reasons their ability to fertilize is impaired but the possibility still exists. There are different grades of subfertility, some of which might require treatment such as surgery or IVF, others simply perseverance.
Diagnosing the cause of any infertility can be difficult: 25% of all infertility is unexplained. Around 30% of infertility cases are related to the man, while 40% overall are related to both man and woman. It is very important to confront infertility as a couple, rather than place individual responsibility.
Diagnosing male infertility
Male infertility is caused by abnormal semen. Often, the cause of the abnormality is unexplained. However there are a variety of possible factors.
- Low sperm count – testicles produce little or no sperm
- Bad sperm mobility – making it hard for the sperm to reach the egg
- Abnormally shaped sperm – making fertilisation of the egg difficult
- Absence of sperm – sperm is produced but fails to reach semen or is not produced at all
- Chemotherapy- can result in any of the above
Compromised testicles can also be a factor. If your testicles are damaged, it can seriously affect the quality of your semen. Possible causes include:
- Testicular cancer
- Testicular infection
- Testicular surgery
- Undescended testicles, where one or both haven’t descended into the scrotum
- Injury to the testicles
- A collection of enlarged veins in the scrotum, just above the testes. This is called a varicocele and is the most common cause of correctable male infertility
Lifestyle causes of infertility
An unhealthy lifestyle can often affect fertility:
- Weight: overweight and obese men are more likely to have a low sperm count and poor quality of sperm
- Alcohol: too much alcohol can greatly compromise quality of sperm.
- Cigarettes: smoking damages sperm, making them less fertile.
- Drugs: regular drug use can affect both sperm quality and count
- Stress: As well as affecting libido, severe stress can reduce the sperm count.
- STIs: although less damaging to male fertility than female, certain STIs can affect quality of sperm.
Erectile dysfunction and male infertility
Severe erectile dysfunction can affect sexual intercourse and therefore compromise the chances of conception. In 80% of men over 40, ED is a symptom of an underlying medical condition. Men over 40 experiencing regular ED should consider a health check-up from their GP to protect against potential underlying causes. Lifestyle factors that affect sperm quality, such as weight, alcohol and smoking, can also cause ED. Sometimes the source of ED is psychological: related to stress, nerves or insecurity. Taking our free ED assessment might help pinpoint the cause.
Sexual dysfunction is a factor in approximately 20-25% of infertile couples. ED can trigger stress and, some cases, serious conflict. This reduces the chance of a conception. ED can be worsened by the pressure of responding to the female ovulation period. This creates a vicious cycle in which male anxiety over potential failure to perform increases the chance of such a failure occurring. Fortunately, whereas infertility is often difficult to treat, ED is generally more straightforward. A number of ED treatments, such as Viagra, are available and often very effective.
Infertility can carry a strong psychological impact such as sadness and anger at being unable to conceive a child. Feelings of inadequacy or being ‘unmasculine’ can sometimes be experienced. As male infertility is less widely covered than female infertility, men may feel unwilling to discuss the subject – which can make it harder to solve the problem. Depression, stress and relationship issues can result from an infertility diagnosis. Discussing infertility and the feelings it provokes, either with a trusted confidante or professional psychoanalyst, can prove beneficial.
Treatments for male infertility
Treatment for male infertility largely depends on its cause. If the man is completely infertile – e.g. he produces no sperm whatsoever – then unfortunately no treatment can correct this. Adoption or a sperm donor are potential options at this juncture. As already noted, complete infertility is very rare and normally as a result of surgery for, say, testicular cancer rather than a natural occurrence.
Normally the man is ‘subfertile’: making fertilization difficult but not impossible. Since treatment depends so heavily on the individual, reviewing potential treatments here will be of little benefit. We recommend visiting a GP to try and diagnose the cause. Four treatments the GP may potentially suggest are:
- Surgery: surgery can treat a varicocele. However experts debate over the effect this surgery has on infertility
- Artificial insemination: if a man has bad sperm mobility, artificial insemination might prove beneficial
- Lifestyle changes: cutting down on alcohol and quitting smoking may help. If overweight, then losing weight through exercise and dieting is important
- Erectile Dysfunction Treatment: if ED is the problem, numerous treatments are available. Take our free ED assessment to find the suitable one for you.
Bear in mind the above treatments concern male infertility, not female. Diagnosis can be very difficult and often the difficulties conceiving are unexplained. Although some treatments may help, there are no guarantees.
Just remember conception can occur after years of trying – infertility isn’t necessarily for life.