Male infertility: low sperm count, causes, tests and treatment

Fertility is often seen as a woman's issue, but male factors can be involved. This article explains what male infertility is, what can cause it, how it is tested and treated, and when to speak to a doctor, using information from MedlinePlus and the NHS.

1. Introduction

Doctors use the term male infertility when a man has not made a woman pregnant after at least a year of trying. MedlinePlus says about one-third of infertility cases stem from the man and one-third from the woman, and sometimes no cause can be found ^[1]. The NHS says that in about 1 in 4 couples no cause is identified ^[2]. Because the problem can lie with either partner or both, the NHS advises that both usually attend appointments ^[3].

2. Common causes

MedlinePlus groups the causes into physical problems with the testicles, blockages in the ducts that carry sperm, hormone problems, a history of high fevers or mumps, genetic disorders, and lifestyle or environmental factors ^[1]. The NHS gives more detail ^[2]:

• Semen and sperm problems. These are a common cause. They include a low sperm count or no sperm, sperm that do not move properly and sperm with abnormal shapes. In many cases the reason for abnormal semen is not known.
• Testicle damage. This can follow infection, testicular cancer, surgery, an injury or being born with undescended testicles.
• Vasectomy. This operation stops sperm reaching the semen. The NHS says reversals are usually unsuccessful.
• Ejaculation disorders. These make it hard to release semen during sex.
• Hypogonadism. This means abnormally low testosterone, which can be caused by a tumour, illegal drug use or Klinefelter syndrome, a genetic condition.

The NHS says higher temperature in the scrotum is linked to lower semen quality, but it is uncertain whether wearing loose underwear helps ^[2].

3. Medicines, drugs and other risks

Some medicines and substances can affect sperm. The NHS lists the following ^[2]:

• A medicine called sulfasalazine can lower sperm count for a time, and levels usually recover after stopping.
• Long-term misuse of anabolic steroids can reduce sperm count and movement.
• Chemotherapy can severely reduce sperm production.
• Some herbal remedies can affect sperm production or reduce testicle size.
• Illegal drugs such as cannabis and cocaine can affect semen quality.

Do not stop a prescribed medicine without talking to your doctor. The NHS says the doctor will ask about all the medicines, herbal remedies and supplements you use ^[3].

Other risk factors listed by the NHS are older age, a body mass index of 30 or more, smoking, heavy alcohol use, sexually transmitted infections such as chlamydia, and exposure to certain pesticides, solvents and metals ^[4]. Stress may also reduce sperm production in severe cases ^[4].

4. Tests

A man who suspects a fertility problem should see a doctor, who can arrange tests ^[1]. The NHS says the doctor asks about children from previous relationships, how long you have been trying, medical conditions, infections, medicines and lifestyle, and examines the testicles for lumps or deformities and the penis for shape ^[3]. The main tests are:

• Semen analysis. A semen sample is checked for sperm count and movement ^[3].
• Testosterone blood test. MedlinePlus lists this alongside semen analysis ^[1].
• Chlamydia test. This is a urine sample, and antibiotics are prescribed if it is positive ^[3].

If needed, the GP can refer you to a specialist infertility team for further tests ^[3].

5. Treatment options

MedlinePlus says that when a cause is found, treatment may include medicines, surgery or assisted reproductive technology, and that many couples treated for infertility go on to have children ^[1]. The NHS describes these options ^[5]:

• Medicines. Gonadotrophins, which are hormones, may improve fertility in men.
• Surgery. An operation can correct a blockage in the epididymis, part of the sperm-carrying tubes. Sperm can also be taken surgically when there is an obstruction, when the sperm tube (the vas deferens) is missing from birth, or after a vasectomy or failed reversal. It is usually an outpatient procedure under local anaesthetic, sometimes general, and sperm that are collected are frozen for later use.
• Assisted conception. In intrauterine insemination (IUI), the fastest-moving sperm are selected and placed straight into the womb. In IVF, eggs and sperm are combined in a laboratory. MedlinePlus also links to information on intracytoplasmic sperm injection (ICSI), another assisted conception technique ^[1].
• Donor sperm. The NHS says donor eggs or sperm are available, and people who registered to donate after 1 April 2005 can no longer stay anonymous ^[5].

The NHS says no evidence supports complementary therapies for fertility problems ^[5]. If you use any herbal or other product, tell your doctor.

6. Healthy habits

Not all male infertility can be prevented. MedlinePlus suggests that quitting smoking, limiting alcohol and keeping a healthy weight may lower the risk ^[6]. The NHS says illegal drugs can affect semen quality ^[2] and that exposure to certain chemicals matters, particularly for men ^[4]. Safe sex helps protect against infections that can affect fertility ^[6].

7. When to see a doctor

See a doctor after a year of trying without pregnancy, or sooner if the woman is 36 or over, or if you have had cancer treatment or may have had a sexually transmitted infection ^[3]. The NHS also says anyone who already knows of a possible fertility problem should go sooner ^[4].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Male factors are involved in many fertility problems, from low sperm count to blocked ducts and low testosterone. Semen analysis is the key test, and treatment ranges from medicines and surgery to assisted conception. Healthy habits may help, and the doctor decides which tests and treatments are right for you.