Common causes of fertility problems in men

About 11 percent of reproductive-age couples in the United States have trouble conceiving or sustaining a pregnancy. About one-third of these cases are due to male fertility problems, about one-third are related to female fertility problems, and the rest are due to factors involving both partners or to unexplained causes.

If you've had regular, unprotected sex for more than a year (or six months if you're older than 35) without conceiving, see your doctor. About 65 percent of couples that get treatment for a fertility problem are eventually able to have a successful pregnancy, according to Resolve, the national infertility association.

A fertility specialist will usually give you and your partner an initial examination. If a semen analysis isn't normal, or if anything in your medical or reproductive history indicates you need a more thorough evaluation, you may be referred to a urologist or other male reproduction specialist who can recommend treatment and help you and your partner decide which assisted reproductive technology options to pursue.

Sometimes, there's a genetic reason for male infertility that could be passed down to children. To rule out this possibility, your doctor may order blood tests and refer you to a genetic counselor to help you understand the results. Read on to learn about the common causes of male infertility and available treatments.

Lifestyle factors and medical history

Certain lifestyle choices as well as your medical history can affect your reproductive system and fertility. You may be more likely to have trouble conceiving if you:

• smoke tobacco or marijuana
• have three or more alcoholic drinks per day
• use illegal drugs
• take anabolic steroids
• take certain medications, including testosterone replacement therapy, or drugs used to treat arthritis, high blood pressure, depression, cancer, infection, or a digestive disorder
• have a chronic illness, such as diabetes, cancer, or thyroid disease
• have poor nutrition
• are significantly overweight
• are exposed to toxins, such as pesticides or lead
• had one or two undescended testicles when you were a baby or child
• have a hernia in your groin
• have had a sexually transmitted infection, such as chlamydia or gonorrhea

If you have any of these risk factors, tell your doctor and discuss what you can do to improve your chances of having a healthy pregnancy.

Varicoceles

Varicoceles are enlarged veins (like varicose veins) in the scrotum. Varicoceles raise the temperature in the testes, which may affect sperm production.

• Possible symptoms: Most men have no symptoms, but some may have scrotal pain that varies from dull to sharp, especially after sitting, standing, or exercising for a long period of time. (Your doctor can check you for varicoceles by doing a physical exam or ultrasound.)
• Possible solutions: Surgery to repair the varicocele, intrauterine insemination (IUI), or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI).

Ejaculation problem

A small percentage of men have a blockage in their ejaculatory duct that prevents sperm from getting into ejaculate fluid. This happens when the epididymis (the organ carrying sperm from the testicles) or the vas deferens (the tube carrying sperm to the ejaculatory duct) are blocked or damaged.

Other men experience retrograde ejaculation. Retrograde ejaculation is when the semen enters the bladder instead of being ejaculated out of the penis because the muscle at the neck of the bladder doesn't work properly.

Infection, injury, diabetes, neurological issues, congenital defects, or a vasectomy can also cause ejaculation problems.

• Possible symptoms: There aren't usually any symptoms, though if you have retrograde ejaculation you may notice cloudy urine or little to no ejaculate after orgasm.
• Possible solutions: IUI or surgery to repair an obstruction, reverse the vasectomy, or remove sperm for IVF.

Sperm count or motility problem

If you have little to no sperm, poor sperm motility (ability to move), or abnormally shaped sperm, your sperm may not be able to fertilize your partner's eggs. Problems with sperm production or quality can be caused by hormonal imbalances, disease or injury to the urinary or genital organs, fever or heat exposure, certain genetic disorders, and various drugs and toxins.

• Possible symptoms: None.
• Possible solutions: Fertility drugs, IUI with donor sperm (or with your own if your count, shape, and motility are sufficient), or IVF with ICSI.

Anti-sperm antibodies

Your body can develop antibodies that lower motility or even destroy your own sperm. This happens most commonly after a vasectomy, testicular torsion (a testicle twisted inside the scrotum), infection, or trauma.

• Possible symptoms: None.

Possible solutions: IVF with ICSI is the primary treatment. You may also take steroids, such as prednisone, to suppress sperm antibodies, but many doctors don't recommend these drugs because of side effects from prolonged use.

Unknown problem

Your doctor may diagnose you with "unexplained infertility" if tests can't pinpoint the reason you're having trouble conceiving. Some experts think there may be various contributing factors, such as exposure to environmental toxins, subtle differences in sperm function or the fertilization process, being at the lower end of the normal range of sperm count and motility, or a combination of these or other factors. More research is needed to explore these theories.

• Possible symptoms: None.
• Possible solutions: Fertility drugs combined with IUI or IVF.