Updated December 2022

Male infertility causes are as important as female infertility. Although male infertility is less common than female, failing to recognise it means the problem is not properly managed.

Infertility is a problem that affects both partners, so fertility treatment does not focus on just one person.

In this post, we’ll look at some conditions that fundamentally cause a man to be infertile.

By doing so, hopefully, we can:

• Increase awareness of these causes.
• Highlight some of the symptoms and help people realize when to seek medical advice
• remove the stigma sometimes associated with the condition.

Male Infertility Causes

Many causes of male infertility can be treated,

Some may be preventable, while others are caused by damage or diseases whose causes are beyond your control.

In many cases, the problems with fertility will commonly be:

• Challenge with producing sperm
• Problem with sperm transport or movement.
• Miscellaneous issues are infections, libido problems, ejaculation or hormonal problems, etc.

Problems With Sperm Production

Genetic/Chromosomal Problems

• Chromosomal or genetic abnormalities.
  • An example is what happens in a condition known as Klinefelter’s syndrome, where boys are born with 3 sex chromosomes instead of the usual pair of 1 X and 1 Y sex chromosomes.
    • Every man and woman has 46 chromosomes arranged in 23 pairs.
    • The chromosome contains genetic material that determines what each person becomes.
    • One chromosome from each pair is inherited from your mother, and the other chromosome from your father.
    • One pair of these 23 sets is referred to as the sex chromosomes.

In women, there are two X sex chromosomes (XX) that make up the pair, while in men, a Y chromosome must be present (XY).

In Klinefelter’s syndrome, there is an extra X chromosome; instead of XY, they have XXY.

 Men with XXY have several typical physical characteristics, including:

• female-type physical appearance with enlarged breasts,
• female-type pubic hair appearance and
• a small penis and testicles – because their testes do not work properly, they cannot have children naturally.

Undescended Testes

• During the development of the male child in the womb, the testes (like ovaries in the woman) are located in the abdomen (tummy).
  • By the time of birth, they will naturally have travelled down into the scrotal sacs.
  • In Undescended Testes, the testes fail to descend at birth.
  • We believe that if the testes remain in the abdomen, i.e. undescended, rather than outside the body in the scrotum, they can no longer produce sperm.
  • In many cases, if it has not happened at birth, the movement of the testes will naturally occur within the first 3-6 months.
  • However, if this still has not happened by 6 months of age, the recommendation is treatment.
  • Boys with untreated undescended testes can have the following:
    • fertility problems in later life and
    • an increased risk of developing testicular cancer.

More Sperm Production issues

Infections

In childhood, infection with Mumps can (rarely) lead to a swelling of the testicles and cause infertility.

More commonly, though, the infections are sexually transmitted infections like

• Chlamydia
  • This infection can damage an important part of the testis called the epididymis leading to infertility
• Gonorrhoea
  • Gonorrhoea can cause painful infections in the testicles and prostate gland, which may reduce fertility in many cases.

Testicular Torsion

This is a very painful condition in which the testis twists on its cord. As you can see in the image above, the testis is carried up or ‘rides high’ inside the scrotal sac on that side.

When this happens, there is damage to its blood vessels which again leads to damage to the epididymis (the site for sperm production).

Varicocele

Also referred to as varicose veins of the testes – again, in this condition, the blood supply to key parts of the testes is affected, which means that they will be damaged and unable to produce sperm.

Medicines and Chemicals

Environmental chemicals can affect the sperm-producing tissues in the testes, affecting their quality and quantity.

As research has shown, examples can include chemicals used in agricultural and industrial sectors.

Medications such as those used in the treatment of cancer can also affect the testes in a similar way.

Radiation Damage

This includes radiation for cancer treatment or exposure to X- rays during tests.

Unknown cause

It is important to say that in some cases, we don’t know and the causes for failure in sperm production are not clear.

Causes That Affect Sperm Transport (Movement)

In these cases, the man can produce sperm of good quality and quantity. However, sperm cannot move from the ‘production factory’ within the testes to the penis for ejaculation during intercourse.

For whichever of the reasons below, the result is male infertility:

Infections

We’ve looked at how infection affects sperm production. Another problem that infections can cause is the effect on sperm movement.

Broadly this refers to different types of infections that can damage the tract through which the sperm will pass en route to the penis.

Examples are sexually transmitted infections such as Chlamydia or Gonorrhoea.

In some cases, sexually transmitted infections do not show any symptoms. They can cause damage to the reproductive passage that may not be obvious for months or years following the infection.

Another type of infection that affects the prostate gland – prostatitis – may be acute or chronic.

Inflammation from infection damages the tissues leading to a blockage in the route through which sperm gets to the penis.

The same type of blockage can arise from a change to its structure – it can happen with either Benign Prostatic Enlargement or Prostate Cancer.

Vasectomy

Surgery like Vasectomy will divide/separate the vas deferens. This tube allows sperm to move from the testis to the penis in the ejaculatory fluid (semen), resulting in infertility.

The tubes that transport sperm and semen run through the prostate gland. The prostate is a small organ that sits behind the bladder in men.

More Sperm Transport issues

After Prostate Surgery

Complications from a Prostate Surgery (which is one possible treatment for Prostate Cancer) lead to infertility as there may be an injury to the nerves and other close-by structures of the penis.

Sexual Problems which lead to Male infertility also include sexually transmitted infections.

Infrequent Intercourse and Erectile Dysfunction

Problems with ejaculation and erection can lead to infertility. It is often anecdotally blamed for infertility problems though it is only one out of several possibilities, as you can see.

It is also important to establish how often you are having sex. Infrequent intercourse may be from physical illness or mood problems causing loss of libido or sexual desire.

Injury to the Spinal Cord

Trauma and accidents will damage the nerve supply to the penis and other male reproductive structures.

It’s clear that many causes can lead to male infertility – some are more common than others.

We’ll look at a few more in the next segment of this topic.

Medicines that Cause Male Infertility

Some medications can lead to infertility as one of their side effects.

• Testosterone replacement therapy:
  • Men who use testosterone replacement therapy for low testosterone levels may find that the treatment shrinks the testes and reduces sperm production.
• Steroids:
  • High doses of steroids like prednisone and cortisone – can lower sperm count in some men.
  • Bodybuilders and athletes who use steroids to enhance performance could be affected.

• Sulfasalazine:
  • This drug treats inflammatory disorders such as ulcerative colitis and rheumatoid arthritis.
  • Sulfasalazine can lower sperm count but usually returns to normal once the drug is no longer taken.
• Cancer treatments:
  • Chemotherapy and radiation therapy are cancer treatments that can damage sperm cells or the ability to produce sperm.
• Antihypertensive medications:
  • Certain drugs used to control blood pressure, such as beta-blockers and diuretics, can cause erectile dysfunction (impotence).
• Antidepressants:
  • Some antidepressants can cause erectile dysfunction or difficulty ejaculating.

READ – How Does Male Sterilisation Compare To Female?

Other Conditions Leading to Infertility

Other conditions that could lead to infertility include:

• Cancer
• Problems in the brain centre (pituitary gland) that controls the hormones which regulate the male reproductive organs.

To identify the cause of infertility in any specific case, the commonest test is the Semen analysis which identifies the following:

• The quality of the sperm
• The quantity of the sperm
• The activity of the sperm – i.e. ability of the sperm to move effectively towards a mature egg and fertilise it.

Click on the following link for a look at the different aspects of semen analysis in greater detail.

Male Infertility – Treating a Problem with Many Causes

The main take-away from all this is – there is no single cure for male infertility problems.

There are many claims about certain treatments that offer a cure for infertility, Diabetes and some other medical conditions thrown in for good measure.

The discussion above should demonstrate that a clearer idea of the cause will lead to better chances of a cure.

If you have concerns about your reproductive health, you can schedule a one-to-one chat with one of our clinicians. We can explore specific enquiries about male and female fertility issues.

Till then, stay well!

More Reading

• Male Infertility Problems By AskAwayHealth
• Age Effects on Fertility – Your Chance of Parenthood
• What Prostate Cancer Looks Like
• Exploring the Link Between Ovulation Pain and Infertility
• Can Frequent Sex Reduce Prostate Cancer Risk?

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various healthcare conditions to help promote quality healthcare. The advice in our material is not meant to replace a qualified healthcare practitioner’s management of your specific condition.
To discuss your condition, please get in touch with a health practitioner or reach us directly.

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