Understanding Male Infertility

Cultural expectations of masculinity can make addressing male infertility a considerable struggle and trigger significant anxiety and even trauma in men.

Reproductive challenges in men aren’t unusual—and they aren’t indicative of insufficient manhood or general vitality. While many believe infertility is “a woman’s problem,” male infertility is a factor in approximately 40-50% of all cases.

Studies have found that men experience a desire for parenthood on par with women. And the good news is many couples can successfully conceive after receiving medical intervention.

What is Male Infertility?

Male infertility is considered a reproductive system disorder in which the male partner is incapable of initiating pregnancy. The male partner’s reproductive system must produce sufficient healthy sperm to achieve conception. He must then achieve erection and ejaculation, effectively introducing the sperm to the egg to fertilize.

Deficiencies in any of these mechanisms can cause male infertility.

4 Types of Male Infertility

Male infertility can be broadly subdivided into four main types:

1. Endocrine or Systemic Causes

Endocrine or systemic causes account for about 2-5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis. This axis is responsible for the regulation of testosterone production and the process of spermatogenesis (sperm cell development). Like most hormonal pathways within the body, the HPG is sensitive to disruption and can indicate other disorders.

While some estrogen and estradiol are necessary for healthy male biological function and reproduction, excess estrogen may upset the balance of the HPG axis and contribute to male infertility.

2. Testicular Defects in Spermatogenesis

Some more common disorders that affect the testicles include trauma, torsion, cancer, epididymitis, and hypogonadism (low testosterone). Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Here are four common testicular issues in spermatogenesis:

• Scar tissue
  Though uncommon, scarring within the testicular tissue may lead to reduced or halted sperm production.
• Testicular torsion
  Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum and halting sperm production. Fortunately, one testicle can produce the amount of sperm needed for fertilization.
• Male hypogonadism
  Male hypogonadism is an acquired or congenital condition in which the body does not produce enough testosterone, sperm, or both.
• Cancer and cancer treatments
  Chemotherapy treatment may adversely affect sperm production and fertility. Patients may wish to speak to their treatment provider about sperm banking before treatment begins.

3. Sperm Transport Disorders

Sperm must successfully reach the female egg for fertilization to occur. If the sperm encounters difficulties reaching the egg, it could cause infertility. Sperm transport disorders account for 5% of male infertility cases.

Causes of sperm transport issues may be congenital, surgical, or acquired through infection or disease. Congenital causes may include:

• The absence of the vas deferens.
• Incomplete development of the sperm ducts.
• Lack of the seminal vesicles which store sperm.

Surgical intervention might include a vasectomy. Infection or disease-related causes of sperm transport disorders could result from a sexually transmitted disease leading to scarring.

4. Idiopathic Male Infertility

Idiopathic male infertility (IMI) affects approximately 10-15% of males in their prime reproductive age. Men presenting with IMI have no apparent history of fertility problems, and both physical examination and endocrine laboratory testing are normal.

However, routine semen analysis reveals sperm abnormalities that come alone or in combination.

Causes of Male Infertility

Male infertility is either related to the inability to produce healthy sperm or caused by structural abnormalities that interfere with sperm release. The failure to produce or release sperm can have medical, lifestyle, and environmental causes. Let’s explore each category below.

Medical Factors

• Erectile dysfunction (ED)
  The inability to achieve or maintain an erection, prevents ejaculation and the release of sperm. ED can be caused by unmanaged cardiovascular disease, diabetes, or high blood pressure, among other issues. Psychological factors like stress and depression may also trigger ED.
• Hormonal issues
  Disordered hormone production can lead to fertility challenges. These may be caused by an undescended testicle, testicular cancer, or adrenal, pituitary, or thyroid disorders. Radiation treatments for cancer may also interfere with hormone signals relating to sperm production.
• Immune response disorders
  Though rare, the production of anti-sperm antibodies can cause male infertility. This typically occurs after a testicular injury or an infection in the prostate.
• Infections
  Infections that inhibit sperm generation and sperm release can be either sexually transmitted (STIs) or non-sexually transmitted. These can cause inflammation, scarring, and blockages, making sperm passage difficult or preventing healthy sperm production. The most common infections include epididymitis, gonorrhea, hepatitis B virus, and mumps.
• Obesity
  Excessive adipose tissue (the connective tissue that stores fat) can cause changes in hormone production that negatively impact male fertility. Overweight and obese men have compromised sperm production and generate greater quantities of sperm with low motility (slow sperm) and abnormal shape than non-obese men.
• Structural abnormalities
  These are anatomical disorders that inhibit the release of sperm, either due to congenital malformations or acquired anomalies through injury or surgery. Spinal cord injuries, injuries to the testicles, bladder surgeries, prostate surgeries, and urethra surgeries can cause ejaculation issues (retrograde ejaculation) and tubule disorders, causing male factor infertility. Structural abnormalities can also inhibit sexual performance, causing pain or the inability to achieve or maintain an erection.

Lifestyle Factors

• Cigarette smoking
  Smokers tend to have lower sperm counts than their non-smoking counterparts.
• Excessive alcohol consumption
  Alcohol can cause reduced testosterone production and inhibit the creation of sperm. It can also contribute to erectile dysfunction and chronic conditions leading to reduced fertility.
• Chronic drug use
  The chronic use of certain narcotics, like cocaine or methamphetamines, can lower sperm quality and production. Regular drug use can also contribute to general health issues, like cardiovascular abnormalities and high blood pressure, compromising fertility.
  Overuse of anabolic steroids may disrupt natural hormone production signals, interfering with the ability to produce sperm.

Environmental Factors

Environmental pollutants have been found to contribute to male infertility. These can come from living for extended periods in industrial regions (near factories, busy highways, refineries), agricultural regions, or parts of the world where water and air contamination are common.

Working closely with toxic substances can reduce sperm count and lead to permanent infertility. Three of the most common types of environmental toxins that interfere with male fertility are:

• Heavy metals
• Pesticides
• Radiation

The team at Pacific Reproductive Center can help you overcome male factor fertility challenges with innovative male infertility treatment protocols and personalized, integrated fertility strategies.

We are committed to offering the support you need to overcome your anxieties about your infertility, help you optimize your overall health, and improve your chances of achieving a successful pregnancy.

Building a family is within your reach.