Causes of Male Infertility:
Male infertility can be due to a number of different causes, some that are reversible and others that require fertility treatments including intrauterine insemination (IUI), in vitro fertilization (IVF) with or without sperm extraction, or use of donor sperm. In some cases, after an initial evaluation, you may be referred to a reproductive urologist for a more comprehensive assessment and treatment.
Listed below are the more common causes of male infertility:
Varicoceles
Bulging veins of the testicles
Infections
-Mumps is a childhood infection that can result in orchitis (inflammation of the testicles) which can results in low sperm production, although rare this more commonly occurs in unvaccinated men
-Epididymitis most often caused by sexually transmitted infections (Gonorrhea, Chlamydia) or other bacteria (tuberculosis), is inflammation of the epididymis- the tube connected to the testes that transports sperm. If scar tissue forms, this can result in partial or complete blockage which can block the sperm from leaving the testes
Environmental toxins
Exposure to heat, smoking, marijuana, heavy metals, pesticides, endocrine disrupting chemicals can significant impact sperm parameters
Genetic mutations or chromosomal abnormalities
-Klinefelter syndrome which is the presence of an extra X chromosome (XXY males)
-Y chromosome deletions (some deletions are more severe than others, regarding the degree of infertility)
-Single gene mutations within genes that are involved in the control of sperm production
Hypogonadotropic hypogonadism
Failure of the brain to secrete important signaling hormones (FSH and LH) for the growth and development of sperm. This could be due to inherited or sporadic mutations, presence of a brain tumor and other infiltrative brain diseases or obesity
Chemotherapy or radiation
Male cancer patients who have received chemotherapy or radiation may have testicular failure which is irreversible
History of vasectomy
Results in permanent obstruction of the vas deferens (this is what transports sperm into the ejaculate)
Congenital absence of the vas deferens
Some men with a CFTR mutation are born without the tube that transports sperm from the testes to be mixed with semen
Drugs
Including anabolic steroids, opiates, testosterone, glucocorticoids. It is important to disclose all drugs you are taking in order to help determine the cause of your infertility
Ejaculatory dysfunction
This may be due to spinal cord disease as well as other emotional or psychologic conditions
Retrograde ejaculation
Also known as a “dry orgasm”, this is where the ejaculate is not properly expelled
Varicoceles
Bulging veins of the testicles
Infections
-Mumps is a childhood infection that can result in orchitis (inflammation of the testicles) which can results in low sperm production, although rare this more commonly occurs in unvaccinated men
-Epididymitis most often caused by sexually transmitted infections (Gonorrhea, Chlamydia) or other bacteria (tuberculosis), is inflammation of the epididymis- the tube connected to the testes that transports sperm. If scar tissue forms, this can result in partial or complete blockage which can block the sperm from leaving the testes
Environmental toxins
Exposure to heat, smoking, marijuana, heavy metals, pesticides, endocrine disrupting chemicals can significant impact sperm parameters
Genetic mutations or chromosomal abnormalities
-Klinefelter syndrome which is the presence of an extra X chromosome (XXY males)
-Y chromosome deletions (some deletions are more severe than others, regarding the degree of infertility)
-Single gene mutations within genes that are involved in the control of sperm production
Hypogonadotropic hypogonadism
Failure of the brain to secrete important signaling hormones (FSH and LH) for the growth and development of sperm. This could be due to inherited or sporadic mutations, presence of a brain tumor and other infiltrative brain diseases or obesity
Chemotherapy or radiation
Male cancer patients who have received chemotherapy or radiation may have testicular failure which is irreversible
History of vasectomy
Results in permanent obstruction of the vas deferens (this is what transports sperm into the ejaculate)
Congenital absence of the vas deferens
Some men with a CFTR mutation are born without the tube that transports sperm from the testes to be mixed with semen
Drugs
Including anabolic steroids, opiates, testosterone, glucocorticoids. It is important to disclose all drugs you are taking in order to help determine the cause of your infertility
Ejaculatory dysfunction
This may be due to spinal cord disease as well as other emotional or psychologic conditions
Retrograde ejaculation
Also known as a “dry orgasm”, this is where the ejaculate is not properly expelled
Evaluation:
General evaluation of the cause of male infertility in our office includes:
* If additional work-up including biopsy is required, you will be referred to a male reproductive urologist
Treatment of Male Factor Infertility:
Treatment varies based on diagnosis however services offered at IVF Phoenix™ include
*Additional treatments such as surgical sperm retrievals are referred to a male reproductive urologist
IUI
After collection, sperm is washed to remove any dead sperm or debris and placed directly into the uterus
IVF with intracytoplasmic sperm injection (ICSI)
This involves injection of a single sperm into a mature egg to create embryos
Hormone therapy, if indicated
Hormone therapy, if indicated
More on Low Sperm & Infertility
Abnormalities in semen parameters accounts for approximately 20% of infertility cases and is a contributing diagnosis in another 20-40% of infertile couples. As a result, evaluation of sperm is a vital portion of the infertility work-up. This is performed by obtaining a semen sample from the ejaculate following masturbation after 2-3 days of abstinence.
WHO parameters of lower reference limits for semen analysis in fertile men includes:
- Volume: 1.5 (1.4-1.7) mL
- Concentration: 15 (12-16) million/mL
- Total sperm number: 39 (33-46) million/ejaculate
- Total motility: 40 (38-42) %
- Progressive motility: 32 (31-34) %
- Normal morphology: 4 (3-4) %
If the first semen analysis demonstrates abnormal results, it is often repeated. This is because there may be large variations between sperm samples and confirmation of largely abnormal semen analysis results is an important step to proceed with additional testing. Unfortunately, most causes of male infertility remain unknown and may not be amenable to treatment however a number of causes can be treated to improve pregnancy outcomes.
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FAQs
Can semen parameters indeed fluctuate from week to week? Various factors can influence the quality and quantity of sperm in semen, leading to variations over time. Here are some potential reasons:
- Abstinence Period: The length of time between ejaculations can affect semen volume and sperm concentration. Longer periods of abstinence can lead to higher sperm counts but may also increase the proportion of sperm that are morphologically abnormal or less motile.
- Lifestyle Factors: Factors such as stress, diet, alcohol consumption, smoking, and drug use can all impact semen parameters. For example, excessive alcohol or substance use can negatively affect sperm production and function.
- Illness or Infection: Illness, especially if accompanied by high fever, can temporarily reduce sperm count and quality. Some infections can also impact semen parameters.
- Heat Exposure: Exposure to heat (like in hot tubs, saunas, or through keeping a laptop directly on the lap for extended periods) can increase the temperature in the scrotum and impair sperm production, leading to temporary reductions in sperm quality.
- Medication: Certain medications can affect sperm production and function, leading to changes in semen parameters.
- Hormone Levels: Fluctuations in hormone levels can impact sperm production. For instance, testosterone levels can have a direct impact on sperm production, and these levels can fluctuate based on a variety of factors.
- Age: While this doesn’t account for week to week fluctuations, it’s important to note that as a man ages, there can be a gradual decline in semen quality.
Remember that semen analysis at a single point in time can give a snapshot of a man’s fertility, but because sperm parameters can fluctuate, sometimes multiple tests are needed to get a more accurate picture. If you have concerns about semen parameters, it’s a good idea to discuss these with your fertility expert who can offer advice tailored to your situation.
Many researchers believe environmental causes explain an ongoing decline in make infertility. Exposure to toxic substances can be harmful, as can exposure of the genitals to elevated temperatures (such as with hot baths, whirlpools or steam rooms), Also problematic is in-utero exposure to Diethylstilbestrol (DES), a synthetic form of estrogen, the female hormone. Finally, men facing the burden of a cancer diagnosis should be aware of the negative effects on fertility of medical treatments such as surgery or radiation.
Behavioral male factors
A higher risk of male infertility is tied to unhealthy behaviors such as smoking, using alcohol or illicit drugs, and being overweight. Other behavioral factors are having certain past or present infections or taking medications for ulcers, psoriasis, depression or high blood pressure.
Get help with male factors
Infertility challenges are frustrating, but we can address all the factors associated with male infertility. Call us today at (602)765-2229 or email us at info@ivfphoenix.com to learn more and get tested. We’ll give you all the information and assistance you need to achieve your goal of starting a family or adding another child.
Infertility isn’t solely a women’s challenge. At IVF Phoenix ™ we want you to understand male infertility factors, which account for half of all cases, according to the American Society for Reproductive Medicine.
Sperm disorders – the most common male infertility factor
Difficulties making healthy sperm can cause male infertility. There may be too few sperm or sperm may be immature, abnormally shaped or unable to swim. Several causes of sperm disorders are commonly reported in men who experience male infertility.
- Infections or inflammatory conditions such as having the mumps after puberty
- Hormone or pituitary gland irregularities
- Immune problems that generate antibodies against sperm
- Genetic diseases such as cystic fibrosis or hemochromatosis
- Erectile dysfunction or premature ejaculation
- Men who have had groin injuries or surgeries either as an adult, or when they were children
- Men who have taken anabolic steroids, most notably testosterone
Structural or inherited male factors can cause issues
Anything blocking the genital tract can hamper the flow of semen. Some items that our fertility specialists or urologists look for:
- A history of a sexually transmitted disease that causes infection or inflammation
- Scar tissue from surgery or twisted or swollen veins in the scrotum
- Liver or kidney disease
- Treatment for seizure disorders
- Any trauma to the testicles, or a prior vasectomy or major abdominal or pelvic surgery
- A history of undescended testicles
- Medication history, most notably the use of testosterone
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Certain medical conditions such as tumors or chronic illnesses such as sickle cell disease
However, nearly one-third of all infertility cases are related to male factors such as low sperm concentration, poor motility, and abnormal sperm shape. While some men require treatment for their infertility, there are a number of things you can do on a daily basis to boost your male fertility naturally.
Testimonials
From the moment we met Dr. Couvaras, My husband and I felt totally comfortable, secure, and well informed. Additionally, the nurses and staff at IVF Phoenix provided prompt, efficient care with both expertise and patience. Whether ordering prescriptions, educating me on how to properly administer medications or explaining options and probable outcomes of specific treatment protocols, Dr. Couvaras, and his team were simply remarkable. I never felt alone, and appreciated the close guidance they provided throughout our entire treatment. I couldn’t be happier with the results! My husband and I are now 12 weeks pregnant, and are absolutely thrilled! I would recommend Ivf Phoenix to anyone who is interested in finding the cause of their infertility. We love and appreciate everyone at Ivf Phoenix, they are a 2nd family to us. We still can’t thank them enough for making our dreams come true!
The staff and Dr. Couvaras were so kind and understanding. They called me by name as soon as I walked in. Dr. Couvaras was incredibly knowledgeable and knew from the first visit what was going on and after tests came back he was 100% right. He was informative, personable and took care of my health needs as a priority. I never felt left on the back burner. Innovative for sure because now I have 3 amazing children!
Dr. Courvaras is the best there is in the infertility world!! Our first baby is here because of him and his team. Our baby is 17 and will be graduating from high school in less than a month!! We have never forgotten him and the gift he helped us have!!
My husband and I are so thankful for Dr. Couvaras and staff. We were struggling to have a family and stumbled across the IVF Phoenix website. We are from Canada and the staff was fantastic to deal with and very accommodating to work with. We always had support no matter what time of the day. We now have the most perfect beautiful little boy to complete our family!!! So grateful and blessed!!!
This is hands down the BEST fertility clinic in all of Az. Dr. Couvaras and Rhoda are amazing!! Not only are they compassionate and helpful beyond expectations they really look at the whole body and systems and get to the root of the problem. If you are even thinking about fertility go see this place first!
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