Few things in reproductive medicine are as vague as the term “male factor infertility.” Male factor infertility refers to anything in the male partner’s history or physical health or on the semen analysis that may affect the ability to produce a healthy baby. Surprisingly, this is one area of medicine where men are understudied compared with women. Relative to eggs, remarkably little is known about sperm.
Let’s review what we know about male factor infertility and the most common questions:
- What is male factor infertility?
- What causes it?
- How is it diagnosed and evaluated?
This is a general overview for anyone trying to conceive or navigating infertility, and fertility treatments, to help you have informed conversations with your doctor.
I use the term “male partner” here to refer to the partner who produces sperm.
What is male factor infertility?
Male factor infertility can occur alone or in combination with a female factor, such as blocked fallopian tubes or anovulation, and it is a very common part of the infertility of couples. Between 30% and 50% of couples experiencing infertility are thought to have a male factor component, though it is difficult to get accurate numbers because not everyone gets tested.
Just as is the case with female factor infertility, male factor infertility often brings up a lot of feelings of guilt and inadequacy. Part of this is because many people (incorrectly) believe that fertility is associated with masculinity. Of course, that is not the case at all — many men with infertility have very healthy and satisfying sexual lives. Men may also experience difficult emotions at not being able yet to build the family they want, and this can make depression and anxiety worse.
Some couples (at times jokingly) try to place the blame for infertility on one partner by assigning fault. Infertility is no one’s fault. It is something that is often experienced by couples, so it is important to work together and support each other during the workup and treatment. Thinking of it that way also helps launch you toward a healthy and supported pregnancy and managing all the challenges of raising children.
What causes male factor infertility?
Of the many different causes of male factor infertility, by far the most common is a low sperm count, which accounts for between 65% and 80% of cases. Low sperm counts can be caused by a number of factors, such as certain genetic conditions or hormonal disorders. One that is potentially reversible is a varicocele.
Varicoceles are enlarged veins in the testicles (think: varicose veins similar to those that occur in legs). These enlarged veins interfere with the body’s mechanism of cooling the testicles, and the excess heat can cause abnormal production in sperm and in turn a decreased amount and abnormal shape of sperm. Many men who have varicose veins do not have symptoms, and varicose veins do not always lead to infertility. If you have a varicocele and infertility, then you should see a reproductive urologist (a urologist who specializes in fertility) about your treatment options.
For the same reasons, heat in other forms is also not great for sperm production. Use of saunas or hot tubs are associated with lower sperm counts. Another study found that men who self-reported wearing briefs also have lower sperm counts, since briefs hold the testicles closer to the body and thus keep them warmer.
Taking testosterone supplements can decrease sperm counts or completely halt sperm production, depending on the dose and circumstances. Smoking can also cause low sperm counts, so it is a good idea to quit smoking if possible before you are ready to conceive.
The remainder of infertility in men is caused by genetic conditions (such as having an extra copy of the X chromosome), hormonal imbalances, trauma to the testes, chronic health conditions, or having received cancer treatment, and a lot is still unknown.
How is it diagnosed and evaluated?
Evaluation for male factor infertility follows the same guidelines as for women. Men in relationships where they are in need of donor eggs and/or a gestational carrier should have an evaluation right away. Men in relationships without these needs should have an evaluation after one year of trying if the female partner is under 35 years old or after six months of trying if she is 35 or over.
If you are in a heterosexual relationship, it is very important for both partners to undergo concurrent evaluation. I have treated many couples who prefer to have the female partner tested first and then to have the male partner tested if nothing comes up on the female partner’s end. This is not recommended because, as I mentioned earlier, male factor can occur along with a female factor.
Similarly, I have also treated couples where the male partner has children with a different partner, and so the couple thinks that they can skip the male partner evaluation. This is also not recommended, because it is very possible for something to have changed in the interim. Overall, without a complete evaluation of both partners, you will end up with an incomplete picture and a treatment plan that may not be the best fit for you.
Luckily, the evaluation for the male partner is relatively simple. It involves a semen analysis and having a provider take a reproductive health history.
The semen analysis is pretty straightforward, especially compared with what is required of the female partner. A semen sample is evaluated under the microscope to make sure that there is enough sperm (count and concentration), that the sperm looks normal (morphology), and that it is moving in the right direction (motility and progressive motility). The sample will need to be evaluated within an hour of it being produced. Many clinics offer you the ability to collect the sample at home in a sterile cup if you live near enough to get it to the lab within an hour; otherwise you can collect it on-site. If there are religious traditions that make it difficult for you to collect a sample this way, there is the option of collecting the sample in a sterile condom.
Much of this can be done by your partner’s reproductive endocrinologist, if you have one. If there are any red flags in your history or if something is abnormal on the semen analysis, then you should be referred to a reproductive urologist for further evaluation. You can expect that the urologist will perform a physical exam and a hormonal evaluation. The treatment options depend on the result of these tests and can involve everything from medication to surgery.
The bottom line
- Male factor is very common and can affect up to 50% of couples with infertility.
- Up to 80% of male factor infertility is caused by low sperm counts. Low sperm count can be due to varicoceles, excess heat exposure to the testicles, and smoking.
- It is important for both the male and female partners to undergo concurrent evaluation. For the male partner, this should include a semen analysis and reproductive health history. If there is anything abnormal on either of these, you should be referred to a reproductive urologist for evaluation.
We recognize that readers of ParentData identify in different ways — read more about our approach to gender-inclusive language here.
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