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Six male infertility causes that may not be obvious

May 16th 2019

Male subfertility can be just as common as female subfertility, so it’s important to be aware of the possible causes.

A number of things can affect male fertility, including general health and lifestyle (for example, smoking, excess alcohol intake and obesity can all impact sperm health), but that’s just part of the picture. There may be underlying causes that aren’t obvious without specialist tests and screening.

Here are six causes of male infertility that may not always be obvious: 

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1: Poor sperm quality

In order to achieve fertilisation, sperm needs to be healthy and able to ‘swim’ quickly to reach the egg as it passes through a woman’s fallopian tubes and down into the uterus. For various reasons however, tests – including DNA fragmentation tests and sperm analysis – sometimes reveal issues with sperm morphology (its size and shape) or motility (the speed at which it moves), for example. Sperm may also contain slightly damaged DNA (DNA fragmentation). All of these things can result in difficulty conceiving, or may also explain why a couple experiences multiple miscarriages. 

It’s sometimes possible for sperm quality to improve naturally, for example by addressing any lifestyle factors that may be directly involved (like stopping smoking and maintaining a healthy weight), but sometimes fertility treatment may be required.

2: Ejaculation problems 

Men will generally be aware if they have ejaculation problems – such as a complete inability to ejaculate (certain medications can cause this as a side-effect) or delayed ejaculation, where ejaculation occurs late or only after the penis is withdrawn. These are sometimes just temporary problems, or there may be underlying psychosexual causes (if this is the case, counselling with a specialist can be very effective). 

Retrograde ejaculation, where semen is released backwards into the bladder rather than exiting the penis, can be less obvious – although you may notice your urine is very cloudy after sex. Nerve damage and muscle weaknesses (possibly associated with diabetes, MS or previous bladder or prostrate surgery) can sometimes cause this, and it may be treatable. However, some couples may need assistance getting pregnant. 

3: Low or zero sperm count

Semen analysis tests can sometimes reveal that the amount of sperm in a man’s semen is very low (oligospermia), or there might be no sperm detected at all (azoospermia). Usually, further tests will be needed to help determine the root cause of the problem, as a number of factors could potentially play a role. These are explored further in the points below.

4: Blockages 

A low or zero sperm count can be due to a blockage or scarring within the epididymis (small tubes located near the testes, where sperm matures) or vas deferens (tubes that carry sperm from the epididymis into the penis). This may mean that while there’s no problem with sperm production, the sperm is unable to reach the semen and exit the body. If a blockage is detected, surgical sperm retrieval (SSR) can be used to collect sperm directly from the testes or vas deferens. You can find more information about surgical sperm retrieval on our ‘Male Fertility Treatments’ page. Another reason for couples to consider an SSR may be if they now wish to conceive but the male partner had previously had a vasectomy.

5: Hormonal causes 

Male hormone profile tests can be useful in determining male infertility causes too, particularly if a very low or zero sperm count has been detected. For example, a condition called ‘hypogonadism’ can sometimes be present from birth or develop as a result of certain illnesses, medications or injury, and this means men aren’t able to produce enough testosterone. This can impact sperm count and erectile function. Long-term use of anabolic steroids can impact testosterone levels within the testicles too, resulting in impaired sperm production. 

6: Genetic causes 

Male infertility may also be due to underlying genetic abnormalities. This may sound alarming but often, fertility problems may be the only indication of the issue. For example, Y chromosome microdeletion (YCM), where advanced genetic screening reveals that certain genes are missing within the Y chromosome, may cause no symptoms at all aside from reduced fertility. Another genetic cause is Klinefelter syndrome, where men are born with an extra X chromosome as well as a Y chromosome. Depending on the severity of these causes, surgical sperm retrieval and IVF may be helpful, but in some cases IVF with donor sperm may be required.

You can find out more about the male fertility tests and diagnostic services available at King’s Fertility on our ‘Male Fertility Diagnosis’ page. The good news is, if underlying causes of male infertility are detected, this is the first vital step towards treating the problem and there’s lots we can do to help.