At Westchester Health, an issue that some of our male patients suffer from is infertility, and we know how stressful and frustrating this can be for men. Fortunately, infertility is not always a permanent prognosis—it can be treated and in a great many instances, can be reversed. In this blog, we hope to dispel some myths and offer helpful information so that men with this condition can get help and hopefully, conceive a child.
What causes male infertility?
Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices, environmental effects and other factors can all play a role in causing male infertility.
Medical causes
A number of health issues and medical treatments can cause infertility, namely:
1) Varicocele. The most common reversible cause of male infertility, a varicocele is a swelling of the veins that drain the testicle and results in reduced quality of the sperm. Although it’s unknown why varicoceles cause infertility, the reason may be related to abnormal testicular temperature regulation.
2) Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis), as well as some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, sperm can still be retrieved in most cases.
3) Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. This can be caused by various health conditions, including diabetes, spinal injuries, medicationsand surgery (of the bladder, prostate or urethra). Some men with spinal cord injuries or certain diseases are unable to ejaculate semen, even though they still produce sperm. However, in these cases sperm can still be retrieved for use in assisted reproductive techniques.
4) Obstruction. An obstruction can occur anywhere between the testicles and the penis.
5) Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them by attacking them.
6) Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, or through other, unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
7) Undescended testicles. During fetal development of some men, one or both testicles fail to descend from the abdomen into the scrotum, the sac that contains the testicles. Decreased fertility is more likely in men who have had this condition.
8) Hormone imbalances. Infertility can sometimes result from disorders of the testicles themselves, or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands.
9) Defects of tubules that transport sperm. Many different tubes carry sperm. These can become blocked due to injury from surgery, prior infections, trauma or abnormal development such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any point, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
10) Chromosome defects. Inherited disorders such as Klinefelter’s syndrome (a male born with two X chromosomes and one Y chromosome instead of one X and one Y) cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
11) Problems with sexual intercourse. These can include trouble keeping an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities (such as having a urethral opening beneath the penis) or psychological or relationship issues that interfere with sex.
12) Celiac disease. Celiac disease, a digestive disorder caused by sensitivity to gluten, can cause male infertility, but this can improve after switching to a gluten-free diet.
13) Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
14) Prior surgeries. Certain surgeries may prevent the presence of sperm in a man’s ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.
Environmental causes
Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:
1) Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
2) Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
3) Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, however, sperm production can be permanently reduced.
4) Overheating the testicles. Elevated temperatures impair sperm production and function. Although research findings are mixed, frequent use of saunas or hot tubs may temporarily impair a man’s sperm count. Sitting for long periods (such as truck driving), wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in the scrotum and may slightly reduce sperm production.
Health, lifestyle and other causes
Some other causes of male infertility include:
1) Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may also temporarily reduce the number and quality of sperm.
2) Alcohol use. Frequent drinking of high levels of alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking may also lead to fertility problems.
3) Tobacco smoking. Men who smoke may have a lower sperm count than those who don’t smoke. Secondhand smoke also may affect male fertility.
4) Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect sperm count.
5) Weight. Obesity can impair fertility in several ways, including directly impacting sperm and causing hormone changes that reduce male fertility.
Symptoms to watch for
The most obvious sign of male infertility is the inability to conceive a child. Although most men experiencing infertility do not notice any other symptoms, other signs and symptoms include:
- Problems with sexual function: difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Recurrent respiratory infections
- Inability to smell
- Abnormal breast growth (gynecomastia)
- Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
- Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
Treatments for male infertility
If you’re experiencing the frustration of infertility, the good news is that there are a number of effective treatments that in many cases can reverse this condition and allow you to father a child.
1) Surgery. A varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
2) Treating infections. Antibiotic treatment might cure an infection of the reproductive tract which may also restore fertility.
3) Treatments for sexual intercourse problems. Medication or counseling can help improve infertility related to erectile dysfunction or premature ejaculation.
4) Hormone treatments and medications. Your doctor might recommend hormone replacement or other medications in cases where infertility is caused by high or low levels of certain hormones, or problems with the way your body uses hormones.
5) Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and decisions. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
Some lifestyle and home remedies you can do that can also help
There are many steps you can take at home to increase your chances of conception:
1) Have sex more often. Having sexual intercourse every day or every other day beginning at least 4 days before your partner’s ovulation increases your chances of getting her pregnant.
2) Have sex when fertilization is most possible. A woman is likely to become pregnant during ovulation, which occurs in the middle of the menstrual cycle, between periods. This will ensure that your sperm, which can live several days, is present when conception is most likely.
3) Avoid lubricants. Products such as Astroglide or K-Y jelly, lotions and saliva can impair sperm movement and function. Ask your doctor about sperm-safe lubricants.
4) Cut out things that hurt your chances of having healthy, viable sperm: marijuana, cocaine, tobacco, and more than two alcoholic drinks a day harm sperm production. Avoid hot baths and whirlpools.
5) Don’t take testosterone or any steroids.
6) Getting enough sleep and good nutrition will improve your fertility.
Have questions about male infertility? Come see us.
If you or your partner are experiencing male infertility and want to talk to a doctor about it, please call (914) 232-1919 to make an appointment with one of our Westchester Health urology specialists. After examining you and conducting a thorough health history, he/she will discuss treatments that will be the most effective for your specific condition, answer all your questions, and possibly order a number of diagnostic tests so that hopefully, you will soon be able to conceive a child. Whenever, wherever you need us, we’re here for you.
By Jerry Weinberg, MD, a Urologist with Westchester Health, member of Northwell Health Physician Partners