Male Infertility FAQ

What health problems can cause male infertility?

Many health problems–from kidney disease to testicular cancer–can result in male infertility. “Whole-body” health problems and metabolic disorders, and ordinary fevers and infections can harm sperm growth. Diseases passed through sex can lead to blocks and scars in the reproductive tract.

Genetic health problems, such as cystic fibrosis, chromosome translocations, or Y-chromosome problems may result in the absence of sperm. Many illnesses can cause infertility. It’s important that you and your partner tell your family and personal health histories to your health care provider.

Can cigarette smoke affect sperm?

Yes. Research shows that routine smoking affects sperm in many ways. It causes sperm cells to be smaller and slower. It harms their DNA. Smoking can also affect the seminal fluid ejaculated with sperm.

Can using steroids for body building cause infertility?

Yes. Steroids taken by mouth or injections can cause your body to stop making the hormones needed to make sperm.

Do abnormal semen analyses or sperm lead to children with birth defects?

Not necessarily. For most couples seeking fertility treatment, the risk of conceiving a child with a birth defect is the same as for the general population. Some problems (chiefly genetic problems) that cause infertility may also cause a greater risk of conceiving a child with birth defects. Couples need thorough exams and advice before beginning fertility treatments.

What’s the main thing I should know about male infertility?

Infertility is not your or your partner’s fault. The American Society of Reproductive Medicine (ASRM) estimates that about a third of infertility cases are due to the male. Another third is due to the female. In the last third of infertile couples, the problem is caused by either a combination of reasons, or, in 20 out of 100 cases, infertility can’t be explained.
In men, few or no sperm is the biggest problem. In women, the common problems are ovulation problems and blocked tubes. But today, technology and surgical tools exist to address many of these problems.

What are assisted reproductive technologies (ARTs)?

ARTs are high-tech methods to join sperm and egg when sex can’t do it. Your health care provider may suggest one or more ARTs if pregnancy doesn’t happen even though sperm are in your semen.

If I have obstructive azoospermia, when should my partner and I consider sperm retrieval with an ART rather than surgery?

Obstructive azoospermia is a condition where there is lots of sperm being made, but there is a blockage of the flow of sperm resulting in no sperm in the ejaculate. There are multiple causes of obstructive azoospermia including vasectomy, sexually transmitted diseases, previous inguinal or scrotal surgery or prostate gland issues. While each case is different, usually there are surgical options to try and alleviate the blockage and try and restore the flow of sperm, though depending on the exact reason for blockage the chance of unblocking may vary widely. You will have to talk to your doctor about your specific case to get an idea how effective surgery would be to unblock sperm.
An alternative in these cases is where sperm is removed from the testicle or epididymis and then frozen to be used later with in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). ICSI has to be used because:

  • The number of motile sperm is often small.
  • The sperm have not developed complete fertilizing ability yet.
  • The sperm don’t move well enough to fertilize an egg on their own.

If I have a varicocele, when should my partner and I consider an ART rather than surgery?

If you and your partner both have fertility problems and she can’t get pregnant naturally, then one of the ARTs may help rather than surgery. But the choice isn’t always clear. You and your health care provider will want to consider:

  • The female partner’s age and ovarian function
  • The chance that a varicocele repair won’t definitely fix your fertility
  • The fact that ART is needed for each try at pregnancy
  • Data showing that a varicocele repair may help IUI and IVF results

Varicocele repair should be preferred if you don’t have ideal semen, but your partner is fertile. On the other hand, IVF, with or without ICSI, should be the first choice when there’s a special need for such methods to treat a woman’s infertility.

Are the pituitary tumors that cause low gonadotropin or raised prolactin levels malignant tumors (cancer)?

No. These are most often benign (not cancerous) tumors in the pituitary gland. If the tumor is large enough, you should talk to a neurosurgeon about having it removed. These tumors are often taken out through the nose.

Considering the harmful effects of oxidants on sperm function, should all infertile men take the antioxidant therapy?

There are very small studies that evaluate the effect of antioxidant therapy on pregnancy rate and show that antioxidant therapy can raise the rate of pregnancy. All the studies have severe limitations, so don’t assume that antioxidant therapy alone will necessarily lead to pregnancy.  However, given the small studies and meta-analyses of these studies showing some positive effect, generally we do like to use antioxidant therapy in our program.

Please speak to your provider about any questions or concerns not addressed here. 

Source: Male Infertility Overview, Kaiser Permanente, The Permanente Medical Group

Source: Department of Urology, The Permanente Medical Group