A third of the cases of infertility in couples are due to male fertility factors. Typical causes of male infertility range from physical to psychological issues; lifestyle choices are also known to impact male reproductive health. Male infertility typically falls under the following eight broad classes:

1. Hormonal Imbalance

Hormones that control the testes and lead to normal sperm production are regulated by the hypothalamus and pituitary. Disturbances in hormones can impede testosterone synthesis and the production of sperm.

Hyperprolactinemia, characterized by elevated prolactin hormone level, lowers sperm generation and libido in men. Treatment with bromocriptine is usually known to alleviate this condition.

Hypothyroidism, associated with reduced thyroid hormone levels also impairs semen quality and libido. Treatment usually consists of lowering dietary iodine intake and thyroid hormone replacement therapy.

Congenital adrenal hyperplasia (CAH) is a condition wherein the pituitary functions are reduced by high adrenal androgen levels. Cortisone replacement therapy may be used to address low sperm counts and poor sperm motility due to CAH.

The pituitary gland secretion of FSH and LH is necessary for sperm development. Low FSH and LH production by the pituitary, known as hypogonadotropic hypopituitarism, causes the gradual loss of the male germ cells (seminiferous tubules and Leydig cells). This condition should be treated by medications, such as Serophene, prior to the complete and irreversible loss of germ cells.

Testicular failure– Very high FSH and LH blood levels may indicated that the testicles have stopped working. Typically there is associated low testosterone levels and low libido.

Finally, panhypopituitarism, or the complete failure of the pituitary gland, decreases secretions of growth hormone, thyroid hormones, FSH and LH, leading to impotence, reduced libido and the loss of secondary sex characteristics. This condition can be treated by hormone replacement therapy.

2. Physical Abnormalities in the Reproductive Organs

Physical abnormalities can hinder sperm production and the passage from the testes to the penis.

For example, the formation of a varicocele, or enlarged internal spermatic veins, can block blood drainage from the testicle to the abdomen. Up to 15% of men are afflicted with varicocele, which leads to decreased sperm counts, abnormal sperm morphology and infertility.  Corrective surgery may be necessary to alleviate the symptoms.

It is estimated that 7% of infertile men have impaired sperm ducts due to genetic defects, or scarring from infections or surgery.

Abnormality in the bladder sphincter may cause retrograde ejaculation, a condition wherein semen is ejaculated into the bladder, leading to low ejaculate volume and cloudy urination. Decongestant medications may be necessary to address the condition.

Premature ejaculation, defined as the inability to control ejaculation for at least 30 seconds after penetration, is another infertility problem.

Moreover, in some men, the testicles may not descend from the abdominal cavity during the course of fetal development. This condition, known as undescended testicles, causes reduced fertility, if not treated as a young child.


3.     Infections and Diseases

Infections, such as brucellosis, chlamydia, influenza, gonorrhea, mumps, smallpox, syphilis, tuberculosis and typhoid, may lead to the atrophy of the testes. The resulting low sperm counts and poor sperm motility, along with elevated FSH and LH levels are usually treated with hormone replacement therapy.

4.     Certain Medications and Surgeries

Medications, such as testosterone replacement therapy, anabolic steroids, chemotherapy, certain antifungal and ulcer drugs, may reduce sperm production. Surgeries, such as vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries and extensive abdominal surgeries, may reduce sperm counts. Treatment usually consists of corrective surgeries, or the retrieval of sperm directly from the epididymis and testicles.

5.     Congenital Disorders

 Genetic conditions, such as Klinefelter’s Syndrome, cystic fibrosis, Kallmann’s syndrome and Kartagener syndrome, may lead to male infertility.

6.     Psychological Factors

It is tricky to isolate psychological causes from physical factors for infertility. Moreover, certain infertility cases may have both psychological and physical contributing factors.

Erectile Dysfunction (ED) affects 20 million US men, and is a result of physical as well as psychological causes. Common causes of ED include diabetes, cardiovascular diseases, high blood pressure, stress, hormone imbalance, pelvic surgery and medication side effects. The symptoms may worsen with psychological trauma, such as anxiety, guilt and low self-esteem.

7.     Lifestyle

Lifestyle factors that affect a man’s fertility include smoking, excessive alcohol use, drugs (e.g. narcotics, anabolic steroids), rigorous exercise, increased scrotal temperatures from tight underwear, poor Vitamin C and zinc nutritional levels, anemia and excessive mental stress.

8.     Environmental Factors 

Environmental toxins, such as lead, pesticides, radiation, mercury, benzene and boron, also negatively affect male reproductive functions.

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