What are the symptoms of infertility in males?

Defined as inability of a couple to achieve pregnancy after at least one year of frequent, unprotected sexual intercourse, infertility affects women and men equally. Up to 15 percent of couples are unable to achieve pregnancy after one year of unprotected sex while 10 percent of couples are unable to have a successful pregnancy after two years. In couples suffering from infertility, about 35 percent of the cases are caused by male factors, 35 percent are caused by female factors, 20 percent are due to both female and male factors, and the remaining 10 percent are due to unexplained causes. These figures indicate that male infertility is a significant contributor to infertility of couples. To get his female partner pregnant, a man must:

1. Produce healthy sperm: That includes proper growth and development of reproductive organs during his puberty, with the testicles functioning properly, and his body must make enough testosterone and the other hormones necessary for sperm production.

2. His sperm must reach semen: After sperm production in the testicles, they must be transported in the tubes until they get into semen for ejaculation through the penis.

3. He must have enough sperm in semen: The sperm count (numbers of sperm found in semen) must be sufficient in order to increase the odds of fertilizing the ovum (egg). A lower-than-normal sperm count is having fewer than 39 million sperm per ejaculate or less than 15 million sperm in every milliliter of semen.

4. His sperm must be both functional and motile: If the function and movement (motility) of sperm is abnormal, the sperm may not reach or penetrate his partner’s ovum (egg).

Male infertility symptoms

The most obvious sign of infertility in men is inability to make a wife pregnant. But in most cases, male infertility occurs because of an underlying problem, such as low sperm production, a blockage preventing sperm delivery, abnormal sperm function, hormonal imbalance, inherited disorder, dilated veins in the testicles, illnesses and chronic health problems, lifestyle choices, injuries, and other factors. So even though most infertile men may not notice any symptoms apart from their inability to make their female partners pregnant, other male infertility symptoms do exist.

Symptoms of infertility include:

1. A lump, swelling or pain in the testicular region.
2. Sexual function problems, such as reduced sperm volume, difficulty with ejaculation, difficulty achieving and maintaining erections, or reduced sexual desire.
3. Inability to smell.
4. Recurrent respiratory infections.
5. Decreased body or facial hair and other signs of hormonal or chromosomal abnormality.
6. Gynecomastia (abnormal breast growth).
7. A lower-than-normal sperm count (total sperm count below 39 million per ejaculate or less than 15 million sperm in each milliliter of semen).

Male Infertility Causes

Male infertility may be caused by a number of medical, environmental and lifestyle issues.

1. Medical causes

a. Varicocele: Refers to the swelling of veins draining the testicles. It’s the most frequent reversible factor in male infertility and it triggers infertility by hampering testicular temperature regulation, which in turn reduces sperm quality. When varicoceles are treated, sperm function and numbers improve, and the outcomes are better than opting for assisted reproductive techniques like in vitro fertilization.

b. Infections: Infections that interfere with sperm health and production or obstruct the passage of sperm, such as epididymitis (inflammation of epididymis), orchitis (inflammation of testicles) and certain sexually transmitted infections like HIV or gonorrhea, may contribute to male infertility. Though some infections may lead to permanent testicular damage, sperm is still often retrievable in most infections.

c. Sperm-attacking antibodies: Anti-sperm antibodies are typically immune system cells which mistakenly recognize sperm cells as harmful invaders and try to eliminate them.

d. Tumors: Cancers and non-malignant tumors of the male reproductive organs and the glands releasing reproductive hormones, like the pituitary gland, may lead to male infertility. In some instances, chemotherapy, radiation or surgery used to treat these tumors may affect male fertility.

e. Undescended testicles: During fetal development, one or both testicles may fail to move from the abdomen to the scrotum (sac that usually contains the testicles). Men who have had undescended testicles have a bigger risk of infertility.

f. Hormone imbalances: Disorders of the testicles and abnormalities of hormonal systems such as pituitary, hypothalamus, adrenal and thyroid glands can contribute to male infertility. Likewise, male hypogonadism (low testosterone) and other hormonal issues can affect fertility.

g. Defects of tubules transporting sperm: Tubes that carry sperm can be blocked through inadvertent injury during surgery, trauma, prior infections or abnormal development, including cystic fibrosis and similar inherited conditions. Blockage may occur at any level, such as within the testicle, in the epididymis, tubes draining the testicle, in the urethra, near ejaculatory ducts or in the vas deferens.

h. Ejaculation problems: During ejaculation, semen may occasionally enter the bladder instead of coming out through the tip of the penis. This is called retrograde ejaculation and it can be caused by various conditions, including spinal injuries, diabetes, medications, and bladder, urethra or prostate surgery. In men with spinal cord injuries or certain diseases, sperm is produced but semen can’t be ejaculated. In these cases, sperm can be retrieved and used in assisted reproductive techniques.

i. Chromosome defects: Abnormal development of male reproductive organs can be caused by inherited disorders like Klinefelter’s syndrome — whereby a male is born with two X and one Y chromosomes instead of the normal one X and one Y chromosomes. Other genetic syndromes related to infertility include Kartagener’s syndrome, Kallmann’s syndrome and cystic fibrosis.

j. Celiac disease: This is a digestive disorder resulting from sensitivity to gluten. It can cause infertility in men, but improves with adoption of a gluten-free diet.

k. Sexual intercourse issues: Problems such as premature ejaculation, erectile dysfunction, painful intercourse, relationship or psychological problems that interfere with sex, or anatomical abnormalities like hypospadias (having a urethral opening underneath the penis) can contribute to infertility.

l. Certain medications: Drugs such as cancer medications (chemotherapy), long-term anabolic steroid use, testosterone replacement therapy, some ulcer drugs, certain antifungal medications and various other medications can impair sperm secretion and reduce male infertility.

m. Prior surgeries: Inguinal hernia repairs, vasectomy, prostate surgeries, testicular or scrotal surgeries, and large abdominal operations performed for rectal and testicular cancers, among others, can reduce the chances of having sperm in the ejaculate. In most cases, the blockage can be reversed surgically or sperm can be retrieved directly from the testicles and epididymis.

2. Environmental causes

Excessive exposure to environmental elements like heat, chemicals and toxins can reduce sperm production and function. Specific environmental factors include:

a. Exposure to heavy metals such as lead.

b. Prolonged exposure to toluene, xylene, benzenes, herbicides, pesticides, painting materials, or organic solvents, which results in lower sperm counts.

c. Overheating the testicles: Elevated temperatures can impair the production and function of sperm. For instance, frequent use of hot bath tubs or saunas may temporarily lower your sperm count. Wearing tight clothing, long periods of sitting, or working for long stretches of time on a laptop may increase scrotum temperature and slightly decrease sperm production.

d. Exposure to X-rays or radiation can lower sperm production, though eventually it will return to normal. But exposure to high doses may reduce sperm production permanently.

3. Lifestyle, health and other male infertility causes

a. Alcohol use: Excessive consumption of alcohol can reduce testosterone levels, decreasing sperm production and causing erectile dysfunction. Liver disease due to excessive drinking also may cause fertility problems.

b. Drug use: Use of marijuana or cocaine may temporarily lower sperm numbers and viability. Anabolic steroids used to stimulate muscle growth and strength can reduce testicle size and decrease sperm production.

c. Tobacco smoking: In men who smoke, sperm counts are generally lower than in non-smokers. Likewise, male infertility may occur in men frequently exposed to secondhand smoke.

d. Weight: Obesity can directly impact sperm themselves or cause hormonal changes that may reduce male fertility.

e. Depression: In men with depression, sexual dysfunction and subsequent infertility can result from erectile dysfunction, reduced libido, or inhibited or delayed ejaculation. In fact, the likelihood of pregnancy is lower in couples where the male partner suffers from severe depression.

f. Emotional stress: Prolonged or severe stress can interfere with various hormones necessary for sperm production and affect sperm count.

So what are the infertility risk factors in men:

1. Being overweight
2. Being severely stressed or depressed
3. Using alcohol
4. Smoking tobacco
5. Using certain drugs
6. Trauma to the testicles
7. Overheating the testicles
8. History of undescended testicles
9. Exposure to certain toxins
10. Having certain present or past infections
11. Prior pelvic surgery, major abdominal surgery or vasectomy
12. Family history of a fertility disorder or being born with such a disorder
13. Certain medical disorders, including chronic illnesses (like sickle cell disease) and tumors
14. Undergoing medical treatments (like radiation or surgery for treating cancer) or taking certain medications.

How can you prevent infertility?

You can do so by avoiding some of the known causes of infertility. For instance:

1. You should not smoke.
2. You should abstain from or limit alcohol consumption.
3. You should stop using illicit drugs.
4. You should lose some weight.
5. You should reduce stress.
6. You should avoid exposure to heavy metals, pesticides and other toxins.
7. You should avoid activities that result in prolonged heat to the testicles.

When should you see a doctor?

You should see a doctor if you’ve been unable to achieve pregnancy after 1 year of frequent, unprotected sexual intercourse. But you may need to see a doctor sooner than that if:

1. You have ejaculation or erection problems.
2. You have low sex drive or any other issues with sexual function.
3. You have discomfort, pain, a swelling or lump in your testicles.
4. You have a history of prostate, testicle or sexual problems.
5. You have previously undergone a penis, groin, scrotum or testicle surgery.

For more information on male infertility and how to deal with it, visit the “St Pete Urology” site.