Posted by Dr Shirani Rajapaksa, MBChB BSc(Hons) MRCP on 28th Jun 2019
What Is Male Infertility? 8 Answers You Need To Know
Couples may not get pregnant straight away once they start trying for a baby - approximately 1 in 7 couples struggle.
Male infertility is a topic that is not widely known or talked about, often due to social stigma. According to the NHS, it is a factor for 1 in 3 couples having difficulty in conceiving. Recent studies are showing a decreasing trend in male fertility, though more research needs to be done before concluding why it may be happening. To overcome any misunderstandings on the topic, it is really important to know what it’s all about since some causes of male infertility can be treated.
What is male infertility?
Infertility is described as the inability of a couple to conceive naturally despite having regular unprotected sex. Doctors diagnose this when a couple has been trying for at least 12 months. When a man has continued low numbers or poor quality of sperm, this is referred to as male infertility.
What is a low sperm count?
A low sperm count is when a man has less than 15 million sperm per millilitre of semen. Less sperm means your chances of conceiving decrease, though you can still get pregnant.
What types of sperm quality problems are there?
There are 2 main types of sperm quality that can affect fertility: motility and shape.
Sperm motility is normally straight and fast, at more than 25 micrometres per second. This motion, called progressive motility, is needed for the sperm to successfully get through the woman’s cervical mucus and penetrate the egg to fertilise it.
Poor sperm motility is observed when less than 32% of the sperm are moving efficiently. Nearly 90% of male infertility problems are due to a low sperm count, but poor sperm motility is also an important factor.
The other less common reason for poor sperm quality is abnormal sperm shape. If the sperm is not able to move well or fast enough to meet or penetrate the egg's membrane, then it may be a factor. On its own, abnormal morphology of sperm is not causative of male infertility.
What are the causes of male infertility?
There are a variety of causes that may not just affect the sperm count, but also the quality. These can be categorised into clinical reasons and lifestyle or environmental ones:
Clinical causes
- Low testosterone hormone levels – known as hypogonadism
- Structural issues – blockage or damage to tubes that carry sperm, either due to illness, trauma or an absence of tubes from birth
- Varicoceles – swollen veins in the scrotum
- Infections – including STDs chlamydia and gonorrhoea, or infection of the prostate gland
- Genetic problem – such as Klinefelter syndrome, associated with small testicles
- Previous surgery to testicles or hernia repairs
- Unsuccessful reversal of vasectomy
- Ejaculation disorders – including erectile dysfunction
- Medications – including testosterone replacement treatment, cancer chemotherapy, certain antibiotics, anti-depressants, and anti-inflammatory agents like sulfasalazine (for rheumatoid arthritis and inflammatory bowel disorders)
Lifestyle/Environmental causes
- Smoking (some studies have also shown that maternal smoking while pregnant can affect too)
- Drinking too much alcohol
- Recreational drug use – marijuana and cocaine
- Anabolic steroid us over a long period of time
- Being overweight or obese
- Overheating testicles
- Stress
- Occupational exposure – such aspesticides, X-rays and heat
Another thing to remember is that male fertility does reduce with age, although to a much lesser degree than in women.
Are there any symptoms of male infertility?
There are no symptoms that are specifically related to infertility in men. However, some symptoms are linked to medical conditions or low hormones, as described above, that may lead to male infertility.
- Symptoms of low hormone levels - changes in mood, problems getting or maintaining an erection, lower sex drive than usual, weight gain, less facial hair (need to shave less often)
- Symptoms of testicular disorders – pain and/or swelling in testicles, prominent veins in testicles
- Symptoms of ejaculatory disorders – cloudy urine after sex
- Symptoms of prostate gland or epididymis (tube at the back of testicles) – pain after ejaculation, difficulty ejaculating during sex, blood in semen
How can I get tested for sperm count and quality?
An easy way to check the sperm count in your semen is by using a home-testing kit. These can be purchased online. Test results do not need to be sent away and can be known as quickly as 10 minutes. Home tests usually record a low sperm count as less than 20 million sperm per millilitre of semen, higher than the international threshold for infertility.
It is important to know that some home tests only measure sperm count and don’t assess sperm motility or shape. A full semen analysis can be done in a laboratory if requested by your doctor. This test analyses all aspects of sperm quality and count based on your semen sample.
When should I contact my GP?
It is recommended to see your GP if you have been trying to conceive for more than 1 year. The doctor will be able to give advice to you and your partner, to better determine what problems may be happening. The doctor will listen to your story and examine both of you as fertility issues affect both partners and can be a combination of both. Tackling any concerns about infertility together as a couple is a surer way of getting through what is a difficult time for many relationships.
Your GP can request a full semen analysis and refer you both to a specialist if required.
Is there anything I can do about a low sperm count?
Yes! The good news is that there are some lifestyle changes you can make that will boost your sperm count. In fact, research that has shown the trend in male infertility has also looked at probable reasons (though yet unproven) – many of which are thought to be related to modern lifestyles, such as reduced activity and unhealthy diets or substance use.
So what can be done? Here are some top tips on timing, diet, and lifestyle.
Timing
Human bodies are naturally driven by cycles of the day and night. Some research has started to look into whether this affects sperm count. Though nothing definitive can be said, sperm count has been shown to significantly higher first thing in the morning and seasonally in spring.
Of course, timing is critical in a woman’s menstrual cycle too. Having sex every 2-3 days during your partner’s most fertile days every month will increase your chances of conceiving even with a lower sperm count. Ensure you use lubricants that don’t affect the quality of your sperm.
Diet
How balanced is your diet? Doctors recommend we consume more fresh fruit and vegetables – for male infertility related to weight gain, stress and conditions like diabetes, this is a good place to start. Cutting down on foods with trans-fatty acids and soy products will help too.
Here is a list of additional foods you can add to your diet to improve the quality and count of sperm:
- spinach, sweet potatoes and red peppers
- To increase testosterone levels:
- Ginseng – best drunk as tea or taken daily as a dried root
- D-aspartic acid – taken as a supplement, though research is inconclusive
- Ashwagandha (Withaniasomnifera) – ancient herb (may also improve sperm count and motility)
- Fenugreek – taken as seed extract supplement
- To increase libido:
- Bananas – also contain vitamins A and C
- Puncturevine(Tribulus terrestris) - a herbal root, but the evidence is weak
- Maca root – taken in powdered or dried root forms
Lifestyle
A general healthy way of living is believed to improve male infertility. These ways, in particular, are known to be effective:
- Regular exercise increases levels of testosterone and improves semen quality. Avoid overexerting yourself, as that can have the opposite effect.
- Minimise the stress in your life. Find whatever works for you, e.g. yoga, meditating, taking regular walks, gardening or relaxing with family or friends.
- Reduce excess weight
- Quit smoking
- Avoid heavy alcohol consumption
- Enough sleep is critical to maintaining good health. Excess or inadequate is linked with low semen quality.
Of course, avoiding other factors such as excessive heat caused by tight pants, work hazards and medication is recommended too.
Summary
If you’re worried about male infertility, it may be worth taking a home test and improving your diet and lifestyle. The dietary top tips, unfortunately, don’t come with a guarantee but are likely to help. For any additional symptoms or concerns, go see your GP.
Reference web pages
https://www.nhs.uk/conditions/low-sperm-count/
https://www.bupa.co.uk/health-information/mens-health/male-infertility
https://www.ivi.uk/blog/male-infertility-your-questions-answered/
https://www.bournhall.co.uk/fertilityblog/common-questions-men-ask-male-infertility/
https://www.medicalnewstoday.com/articles/320160.php
https://www.medicalnewstoday.com/articles/318963.php
https://www.eurekalert.org/pub_releases/2017-07/thuo-css072017.php
https://www.healthline.com/nutrition/boost-male-fertility-sperm-count