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What are the causes of male infertility?

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10 fertility expert(s) answered this question

Answer from: Saghar Kasiri, Clinical Embryologist

Embryologist, Director of European Operations
Cryos International
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Male infertility can be divided into whether it’s an anatomical problem so, for example, blocked tubes that will allow the sperm to come out of the body and therefore becomes azoospermic, it can be due to lack of production of a sperm in the testicles for some reasons that can be genetic, sometimes it can be hormonal and also it could be due to some illnesses during the childhood for like, for example, like polio. It could also be related to testicles when they were a baby, the man that was born as a baby did not have his testicles out of the body and he had to be surgically moved outside the body, it can also be due to some environmental factor, for example, where they work. We know that the testicles need to be outside the body for a specific reason and thus to keep the sperm at lower degree, at least two degrees lower than the rest of the body – at 37 is the body temperature and the testicles are around 35 degrees – this is to help production and for also sperm to develop normally. Now, if men also work in areas that are like bakeries or very heated areas that can increase the temperature of this testicle, we know it can affect their production and development of sperm and cause infertility. So, infertility can have various reasons, it could be varicocele or it could be something as simple as a lifestyle that needs to be changed like smoking, drinking, taking drugs or a heavy weight or low weight.

Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc

Gynaecologist, Fertility specialist and Gynaecologist at London Womens Clinic
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It could be life style related, environmental toxins, smoking, heavy drinking, drug abuse, men who have protein shakes and anabolic steroids, if there is heat exposure to the scrotal or groin area which can be from hot tubs, saunas or Jacuzzi’s to name a few examples, or tight supportive underwear, prolonged cycling everyday for extended periods of time, anything with generalised heat in the scrotal area  could affect the sperm numbers and quality. One other part could be the system of control. The brain controls the testicular function through two hormones called FSH follicle stimulating and luetinising hormone, FSH and LH, so that hormone and system could be at fault and we call it hypogonadotropic hypogonadism, that those FSH and LH hormones are not coming in an adequate amount to stimulate the testicles, so that could be a pre testicular cause. Or there could be some form of trauma to the testicles, an operation on the testicles, maybe even torsion which could lead to defective blood supply and disturbs the testicular function. Some boys, when they are born, have undescended testes so it may be on one or both sides. So the testes are undescended and not in the scrotal sack and they remain at a very high temperature closer to the body and that is not good or ideal for sperm production. This has to be recognised and corrected as soon as possible. If this is delayed it could lead to a low sperm count as an adult, so boys who have an undescended testicle operation as a child, should check their sperm and semen analysis soon rather than later after puberty because if the sperm is there it can be frozen as a back up, as a method of fertility as sometimes we see that men with these histories, specifically if it was corrected late, come and find that there is no sperm in their ejaculate. It could also be obstruction, so infection is a common cause. If someone has a sexually transmitted infection or another infection, in the testicular area such as mumps – a viral infection which leads to swelling in the neck, but in some cases can affect the testes as well and can lead to testicular infection. This in turn can lead to obstruction and scarring and the sperm is not coming out. So this could be a reason, pre testicular and post testicular  causes.

Answer from: Alexia Chatziparasidou,  MSc, PMI-RMP

Embryologist, Consultant Clinical Embryologist, Director of Embryolab Academy, Co-Founder of Embryolab Fertility Clinic
Embryolab Fertility Clinic
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This is one of the biggest challenges nowadays because we may have a a number of different phenotypes that are linked to male infertility such as azoospermia, asthenospermia or oligospermia but at the same time, in very very few cases we do know the underlying pathology and in most of the cases, we know that there are more than one causative factor so we may have the same phenotype (such as asthenospermia) with lots of potential cause of the factors underlying. So nowadays, what we do is once male fertility is diagnosed, we aim for a very detailed medical history taken by a specialist such as an andrologist in order for secondary factors to be acknowledged such as the use of a kind of medication or anabolic abuse or drug abuse, history of drug abuse or history of chemotherapy. All of these secondary factors may have a severe impact on male fertility. So, once these secondary factors are acknowledged, then we may aim to improve a man’s infertility. This is possible by the cessation of these medications let’s say but what if we have no secondary factors present, then the male infertility is termed idiopathic and unfortunately in these idiopathic male infertility cases, there are only very few cases that have been linked to efficient therapeutic options such in case of hormonological disruption or in cases of an infection. In all the rest of the cases, idiopathic male infertility is not linked to an efficient treatment option and so these males cannot hope for a recovery of their fertility. So for these men, IVF or in terms of conventional IVF or IUI or ICSI is the only option and the good news is that for these men, the success rate normally provided by the assist reproduction techniques are very high and very promising for them. So they should keep on hoping that they will eventually become fathers despite the fact that we do not currently have in our hands good and efficient and targeted therapeutic options for them to hope for recovery of their fertility.

Answer from: Kevin McEleny, BSc(Hons), BM, FRCS(Eng), FRCS (Ed), FRCS(Urol), PhD

Urologist, Male fertility specialist, Urologist at Newcastle Fertility Centre
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It can be quite confusing when you look at it but a good way of looking at it is to break it up into problems that are due to the hormones that supply the testicles, problems are due to the testicles abilities to make sperm and problems due to the testicles sperm became unable to get out for one reason or another. In terms of the hormonal ones, it can be due to problems with the glands in the brain that regulate the hormones that produce sperm and the testicles. This could lead to problems with the pituitary gland or the hypothalamus or structures in the brain. It can also be due to a man taking steroids for say gym work which can suppress these hormones and that can affect sperm production also. Lifestyle factors, obesity etc., could have an impact. A more subtle impact for your hormonal mechanisms than also perhaps in this way. Production type problems can vary from the situation where man’s had some damage to his testicles from say an infection or an injury or an operation. Something more profound that could be caused by exposure to chemotherapy or radiotherapy or to an underlying genetic problem that affects their body’s ability to make testicles like Klinefelter syndrome. In some cases, though the sperm is being made but can’t get out this could be due to a blockage at some point between where the sperm is made when it comes out the end of the penis, there’s blockages normally in the cap at the top of the testicles. Obviously, it can be in the pipe the vast majority of man’s had a vasectomy. Also bear in mind there was some measure of difficulty in ejaculating, and some men have difficulty maintaining erections. So, these are the quota’s things, reasons can be important to ask about too as they can lead to male fertility problems also.

Answer from: Stephen Davies, BSc MBBS DCH DRCOG

Gynaecologist, IVF specialist & retired NHS GP
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People are thinking about conception that they’re aware that there are things that may have happened to them in the past that are highly relevant to the chance of them getting pregnant and on the man’s side, again, as I alluded to previously, infection, perhaps testicular trauma sport related or rarely these days but sometimes occupational issues (certainly historically have been a factor in terms of heat and solvent exposure) and things like that. So I think there are a lot of things and there may be things, not that it doesn’t form a large part of it but there may be some genetic factors that might come in. Again, in terms of physical appearance, it may well be that the primary care physician is aware of an underlying genetic problem, that’s already been diagnosed or they may look at somebody and wonder about genetic abnormality which might mean that there’s an impairment of fertility on either side of the equation really.

Answer from: Malini Uppal, MBBS, DGO Diploma Prenatal Genetics and Foetal Medicine

Gynaecologist, Medical Director and PR to HFEA
GENNET City Fertility
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If there are any issues with the semen parameters, then this triggers further investigation, looking into the hormone profile of the man, depending on what the problems are that we are seeing in the semen assessment. I would refer them to an andrologist and also for an ultrasound of the scrotal region to see if there are any varicoceles, any dilated veins, lumps or cysts in the testicles and also perform a male hormone profile which would include FSH, LH and testosterone levels to see if there is a reason such as is it starting from the brain, in the center where all the hormones are being released. Also are there any endonagatrophic reasons or hormonal reasons that we could find while the sperm production is not normal.
If it comes to the point where there is no sperm found, it then leads to further investigations where we would do blood tests for their karyotype, look at their chromosomal arrangement of the male partner, look for Y chromosome deletion (specific deletions) or oligozoospermia which means decreased sperm count or azoospermia where there is no sperm. Again, a male hormone profile and look for mutations like cystic fibrosis where we can have an absence of vas deferens which means there is no transfer of the sperm into the semen

Answer from: Michael Carroll, BSc, PhD, PgCAP, CBiol, FRSB, FIBMS, FHEA, FLS, ANSHCS

Embryologist, Reader (Associate Professor) in Reproductive Science at Manchester Metropolitan University
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When we look at what results in male fertility is, the quality of the sperm, a poor quality sperm. So, a good sample of sperm would be an ejaculator containing sperm that has a high number of sperm (over 15 million sperm per ml), good motility that means the sperm can swim really well and and fast and the shape of the sperm good, good shape of the sperm morphology. Now factors that can lower those parameters or those characteristics of sperm can be varied. It can be as simple as a testicular injury or torsion to diseases such as diabetes can cause post sperm quality. There are other factors which are becoming more known in the field of reproductive medicine such as environmental and lifestyle factors. These can impact sperm quality also. So when we look at poor diet, when we look at occupation for instance or we look at different types of leisure activities – anything that can increase this growth temperature, can decrease sperm number and sperm count and then diet – anything that’s a very very poor nutrition or very high in fats has been associated with poor sperm quality also. So, again, there’s many many different factors that can have an impact on sperm quality, those that can be changed or altered such as lifestyle, environmental may have a positive impact on fertility outcomes for men.

Answer from: Apostolos Georgiannakis, M.Sc., Ph.D

Andrologist, Sperm Quality Specialist
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The reason for a male infertility can be either due to genetic factors, or men having certain genetic conditions such as Klinefelter Syndrome or cystic fibrosis. It can be due to other medical reasons such as a chronic inflammation going on in the epididymis what we call an epidermidis or an inflammation in the testicle – orchitis. i]It can be due to the presence of varicoceles where we have an increased blood flow in the testicle which can increase the oxidative stress of the testicular environment and hence affects the production of the sperm. It can be other medical reasons such as, for example, diabetes. It can be due to environmental factors, for example, someone’s frequent exposure to chemicals such as pesticides or radiation and of course it can be due to someone’s lifestyle, for example, if they consume large amounts of alcohol, they do drug abuse or steroid abuse.
Overall, the causes of male infertility can be genetic, can be due to the presence of other chronic diseases, it can be through previous past conditions, for example, if someone had undescended testicle at a young age, it can be through to lifestyle factors and it can be through due to environmental factors – someone’s as I said someone’s exposure to damaging harmful substances.

Answer from: Sheena Lewis, Professor of Reproductive Medicine

Andrologist, CEO Examen, Executive committee ARCS
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If a man is having problems conceiving with his partner then he ought to go and see a doctor who specializes in male reproductive health. Now, as we know most of the fertility clinics focus on the woman and that’s because they are staffed by gynecologists. It’s also important now that we know that 50% of the problems are male and 50% are female, it’s also important that the man is checked out and has a clinical history: did he have mumps when he was a child or has he had injuries that might have affected his sperm quality or does he have an infection, does he have a varicocele. Something like about 40% of men who are having difficulties in fathering children have varicoceles and a varicocele is like a varicose vein on the testes, on the scrotum and as we know the testes are outside the body to keep them cool because that’s where sperm like to be at 35 degrees instead of 37 but if they have varicose veins around the testes, then that increases the temperature and that can decrease the quality of their sperm and decreases their chances of becoming a dad.

Answer from: Victoria Walker, MD

Gynaecologist, Fertility Specialist
Institut Marquès
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The next question is, what are the causes for male infertility? This is a very big question to answer in five minutes. I think it’s helpful to think of the man’s anatomy when trying to ascertain the possible causes of male infertility. If you imagine you’ve got testes, and you’ve got tubes, so the sperm is created in the testes and has to come out via these quite long tubes to make an ejaculate sample. So one cause of male infertility would be that the tubes are blocked somewhere along the line. Sometimes that can occur naturally, but sometimes it’s been created by surgery, such as a vasectomy. So sometimes, we’d have infertility, and maybe a man has had a vasectomy because he’s already had a family and didn’t want anymore. And now he has a new partner, but he’s not producing any sperm because the tube has been cut. But then again, maybe the tubes are fine, but the man in the testes is not making any normal sperm. And this means that his ejaculate sample will contain water and salt but won’t contain any sperm. Then sometimes, the tubes are fine, and so the tubes are open and the testes are producing sperm. But a man may have been exposed to some toxic chemicals like smoking or heavy metals, air pollution. And this can reduce the quality and quantity of sperm that a man can produce.

So how you work out what the cause is? As with everything in medicine, history is really important. And so in history, sometimes, when you speak to the patient that can help you, it will indicate what might be wrong. If a patient explains that his testes didn’t descend properly, when he was a child, or he had operations on the testes or hernia repairs, then we might be starting to think that there’s a structural problem with the testes. That might be related to a problem with sperm production on a genetic level. However, if a man has a job that exposes him to chemicals, so he might work in the printing industry or the petrochemical industry, that might be the cause.

How do we know if a man’s sperm might be infertility cause a couple is sharing? When you speak to a couple that might have a male fertility factor, you’ll often find out that they have a long history of infertility, and they’ve had maybe multiple miscarriages. But the woman herself is still young. She still seems to have quite a good ovarian reserve, and nothing is wrong with her uterus. And that’s when the alarm bells start to ring that there may be a male contributing factor. Often, of course, the sperm test, the seminogram will be the starting point for the investigations. But you can do a blood test to look at the chromosomes, and genetic tests in ejaculate samples such as the DNA fragmentation test or the FISH test can be done.

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What are general causes and how many man could be impacted statistically as per the cause?

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