Male infertility – the causes and treatments

Many men are told that they will never be biological fathers and not told that there are options. There are many treatments for male infertility and with some expert advice and support you may be able to become a dad.

Being told that you have a low or zero sperm count is a major blow and the emotional impact shouldn’t be underestimated.

Some of the men we see at Bourn Hall already suspect they might have a problem with fertility, as they know a childhood illness or a sporting injury may have damaged the testes, where the sperm are made and stored. For others the news comes a complete shock.

Even with little or no sperm in the semen there are ways that you can become a father, so this information is just the start of the journey. It is important to get good advice from a specialist to rule out any underlying health issues and make sure you are full informed about your options.

Bourn Hall Clinic has a medical team with years of expertise in treating infertility of all kinds, including consultants such as Mr Oliver Wiseman who is one of only a handful of urologists in the country to specialise in male fertility treatment. Together they are able to offer a full range of treatment options to help you maximise your chances of having a child.

Causes of male infertility

How and where is sperm produced?

Behind the penis is the scrotum which contains the testes, where the sperm and the male sex hormone (testosterone) are made. The sperm leaves the testicles and goes into a tube called the epididymis and then the vas deferens where it is stored.

When you ejaculate, the sperm mixes with fluid from the prostate and seminal vesicles to form semen. During sex the semen travels through the urethra  and into the woman’s body through her vagina.

From the vagina it travels through the cervix, into the uterus and then up into her fallopian tubes. If one of the sperm meets an egg then fertilization happens and an embryo is formed which becomes a baby.

Common causes of male infertility

Male infertility is caused by an absence of sperm or sperm of a poor quality.

Poor sperm quality 

Sperm quality and quantity can vary greatly and is affected by your health and nutrition. All semen contains a proportion of poor sperm that can be abnormally-shaped or unable to swim; the problem occurs when there aren’t enough good sperm – sometimes there are no sperm at all.

In some cases it is possible to boost sperm production through lifestyle changes, supplements or medication and this might be sufficient to improve your chances of natural conception. Other options include: intrauterine insemination (IUI), where the sperm is injected high into the uterus; or IVF, where the eggs are collected and a single sperm injected sperm directly into the egg, a process called ICSI.

Lack or absence of sperm 

There are two main reasons for a low or zero sperm count. The first is that the sperm are not being made in the testes (non-obstructive) this can be a hormonal issue. The second is where a blockage prevents the sperm from reaching the ejaculate (obstructive).

It is important that men with absent or low sperm numbers are thoroughly investigated, to ensure that they do not have an underlying illness causing their infertility or a genetic problem. For example, some men are carriers for the cystic fibrosis gene and may be unaware as they do not have any symptoms of the condition, however, this can mean they have been born without a vas deferens.

If a genetic issue is identified then the couple can be counselled about the chances of passing a genetic problem onto their offspring, and also about the chances of success if surgical sperm retrieval is required.

Non-obstructive causes of male infertility

The manufacture of sperm can be affected by a number of problems, including:

  • Genetic conditions, such as Y chromosome microdeletion or Kleinfelters syndrome, may cause there to be no sperm or very reduced number of sperm in the ejaculate.
  • Testicular problems, such as undescended testicles or a previous twisted testicle, may render the testicle unable to produce sperm.
  • Toxins – some drugs including steroids used in weight training and chemotherapy, may damage the testicles’ ability to manufacture sperm.
  • Previous illness, such as measles may impair sperm production by the testicles.
  • A hormonal problem (hypogonadotrophic or hypogonadism) can lead to insufficient hormones being available to support sperm manufacture.

Obstructive causes of male infertility

There are many reasons why the tubes that transport the sperm can become blocked and these include: sports injuries; infections, such as mumps, chlamydia or gonorrhoea; birth defects or a previous vasectomy or failed vasectomy reversal.

Another common problem is a varicocele, which is a collection of dilated veins which surround the testicle. The veins may visible when the man stands up and may cause discomfort or aching.

The link between varicocele and fertility is much debated. Although varicoceles are present in 30 to 40 per cent of men with infertility, many men with the condition are able to conceive without problems. Correction of the varicocele may lead to improvement in sperm number and quality, so it is recommended that a significant varicocele should be treated to try and improve sperm quality.

Unexplained and combination infertility

Unexplained infertility accounts for 25 per cent of all fertility problems and is a term used when doctors can’t find a cause for infertility after a full series of tests and assessments.

Sometimes being significantly overweight or underweight, exercising excessively or even environmental toxins may be contributing factors. Improving your lifestyle, with better nutrition and regular unprotected intercourse (twice a week) may be sufficient to conceive. However if you still haven’t conceived after two years of trying (including the year before fertility investigations) IVF is usually considered the best option.

Combination infertility – this is where there are both male and female infertility problems, or when one partner has more than one fertility problem. A combination is diagnosed in about 40 per cent of cases. Symptoms vary, depending on causes and so do the treatments.

When no sperm are detected surgical sperm retrieval may be an option

If no sperm is detected in the semen, it might still be possible to find healthy sperm in the testes or the tubes with surgical sperm retrieval (SSR).

PESA (percutaneous epididymal sperm aspiration) treatment may be appropriate where the cause of infertility is obstructive.

Where the cause is thought to be a problem with sperm production then micro TESE (microsurgical testicular sperm extraction) can be used. This is where individual areas of the testicle are inspected under a high-tech microscope to identify those tubules that are dilated and thus more likely to contain sperm. These tubules are then examined to look for and retrieve sperm.

A consultation with a male fertility specialist will allow you to find out more about these options.

Oliver Wiseman, specialist on male infertility
Oliver Wiseman, specialist on male fertility

More information about causes of male infertility

The Men Talk section of our Fertility Blog may provide some useful information for you.

Common questions that men ask about fertility can be found here.

We offer a free consultation with a fertility nurse specialist for anyone concerned about fertility – you don’t have to be trying for a baby

Read some of our case studies on male infertility involving micro tese for zero sperm count and where donated sperm is needed.

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