Symptoms

The main sign of male infertility is the inability to father a child. There may be no other obvious signs or symptoms.

However, in some cases, an underlying problem such as a hereditary disease, hormonal imbalance, dilated veins around the testicles, or a condition that blocks the passage of sperm causes signs and symptoms. Signs and symptoms you may notice include:

• Problems with sexual function – for example, difficulty ejaculating or low ejaculate decreased sexual desire, or difficulty maintaining an erection (erectile dysfunction).
• Pain, swelling, or a lump in the testicle area
• recurrent respiratory infections
• inability to smell
• abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
• A lower than normal sperm count (less than 15 million sperm per milliliter of seminal fluid or a total sperm count of less than 39 million per ejaculate)

When to see a doctor

See a doctor if you have been unable to conceive a child after one year of regular, unprotected sexual intercourse or earlier if you have any of the following:

• Erection or ejaculation problems, low sex drive, or other problems with sexual function.
• pain, discomfort, a lump or swelling in the testicle area
• A history of testicular, prostate, or sexual problems
• Surgery on the groin, testicles, penis, or scrotum
• A partner over the age of 35

Causes

Male fertility is a complex process. In order for your partner to get pregnant, the following must happen:

• They must produce healthy sperm. This first involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning properly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
• The sperm must be transported into the seminal fluid. Once the sperm are produced in the testicles, they are transported through fine tubes until they mix with semen and are ejaculated from the penis.
• There must be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, the likelihood of one of your sperm fertilizing your partner’s egg is reduced. A low sperm count means less than 15 million sperm per milliliter of seminal fluid or less than 39 million per ejaculate.
• Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.

Medical Causes

Male fertility problems can be caused by a number of health problems and medical treatments:

• Varicocele. A varicocele is a swelling of the veins that drain the testicle. It is the most common reversible cause of male infertility. Although the exact reason why varicoceles cause infertility is not known, it could be related to abnormal blood flow. Varicoceles result in decreased sperm quantity and quality.
• Infection. Some infections can affect sperm production or health, or cause scarring that blocks sperm passage. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can cause permanent damage to the testicles, sperm can still be retrieved in most cases.
• Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of exiting the tip of the penis. Several health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery on the bladder, prostate, or urethra.
• Antibodies that attack sperm. Anti-sperm antibodies are cells of the immune system that mistakenly recognize sperm as harmful invaders and try to eliminate them.
• Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that secrete reproductive hormones, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation, or chemotherapy to treat tumors can affect male fertility.
• Undescended testicles. In some men, one or both testicles fail to descend from the abdomen into the scrotum during fetal development. The likelihood of decreased fertility is greater in men in whom this has occurred.
• Imbalance of hormones. Infertility can result from disease of the testes themselves or from an abnormality in the testes.

Complications

Complications of male infertility may include:

• Stress and relationship problems related to the inability to have a child
• Expensive and complex reproductive techniques
• Increased risk of testicular cancer, melanoma, colon cancer, and prostate cancer

Prevention

Male infertility is not always preventable. However, you can try to avoid some known causes of male infertility. For example:

• Do not smoke.
• Limit or abstain from alcohol consumption.
• Stay away from illegal drugs.
• Maintain a healthy weight.
• Do not have a vasectomy.
• Avoid things that cause prolonged heat to the testicles.
• Reduce stress.
• Avoid contact with pesticides, heavy metals, and other toxins.