What Causes Male Factor Infertility
Sperm health is an essential piece of the puzzle for a successful pregnancy, yet most people are surprised to learn that 40 to 50% of all infertility challenges involve or are due to male factor infertility. When getting pregnant doesn’t happen easily, we often focus first on the female partner and people who carry pregnancies. I would like to advocate for a team approach when it comes to couples who are trying to conceive, since it does take 2 ingredients to make a pregnancy happen.
Sperm health has been declining in men’s reproductive systems at alarming rates in recent years, and it doesn’t seem to be slowing down. People who have experienced a difficult time trying to conceive, failed reproductive techniques like IVF (in vitro fertilization) cycles or other infertility treatments, pregnancy loss, or unexplained infertility should keep sperm health on their radar as a possible factor. Let’s take a look at what causes potential problems for sperm and male fertility.
How to find out about your sperm health
A semen analysis is the best place to start to understand your or your partner’s sperm health. What is considered normal in 2022? According to the World Health Organization (WHO), a normal semen analysis includes the following ranges:
- Total sperm count in ejaculate: 39-928 million
- Ejaculate volume: 1.5-7.6 mL
- Sperm concentration: 15-259 million per mL
- Total motility (progressive and non-progressive): 40%-81%
- Progressive motility: 32%-75%
- Sperm morphology: 4%-48%
Basically, we want to know how many sperm there are (total sperm count), how many are swimming in a progressive forward motion (progressive motility), and how many are normal in shape (morphology). Another useful test is for sperm DNA fragmentation, which shows any damage to the strands of DNA of the sperm.
Cause of male infertility
Lifestyle factors play a huge role in male fertility problems and sperm health. Common causes of male infertility include what we put into our bodies and what we expose our bodies to. This can all have high risk for our overall health and the health of sperm. Alcohol, diet, smoking, drug use, exposure to heat, and even certain doctor-prescribed medications can negatively impact sperm. Environmental toxins are also an issue and are getting a lot of attention right now, and rightly so, as we are surrounded by chemicals that affect our overall health daily.
Here are some specifics:
Alcohol
Having a few drinks a week (less than 7) seems to be okay if you have healthy sperm, but heavier drinking, and especially binge drinking, can have detrimental effects on sperm count, motility, and morphology. Luckily, by pulling back on your intake, you can often improve your numbers relatively quickly.
Cannabis
All forms of cannabis, including CBD products, result in low testosterone levels and are found to lower sperm count and motility and cause abnormal sperm morphology. A recent study found that when male partners used cannabis more than once a week, the risk of pregnancy loss was higher than those who did not use cannabis. The effects on sperm health are reversible here, so abstaining is the best practice.
Tobacco
If you are smoking or using tobacco, it is recommended to quit as soon as possible before trying to conceive, because the toxic chemicals in tobacco products cause a decrease in sperm count and motility as well as abnormal morphology (shape of the sperm).
Diet
Eating any foods that contain hormones, like full-fat dairy and soy products, can cause hormone imbalances and decrease the number and quality of sperm. Non-organic meat and dairy can both contain hormones. Nitrites in processed foods can also cause damage to sperm DNA.
Drug use
Recreational drug use of cocaine, heroin, opiates, and/or methamphetamines can cause an increase in abnormal sperm and a decrease in sperm motility and volume as well as sexual dysfunction and should be abstained from completely while trying to conceive.
Medications
The effects of certain doctor-prescribed, FDA-approved medications can usually be reversed, though there is a lot that we still don’t know about their long-lasting effects. The longer you are on certain medications, the longer it can take for your body to rebalance and your sperm parameters to improve.
Hypertensive medication
People with hypertension (high blood pressure) and those taking medications for hypertension like calcium channel blockers, beta-blockers, and angiotensin receptor blockers can have a decrease in sperm volume, concentration, and/or motility. There is conflicting information as to whether ACE inhibitors cause a decrease in sperm health, but some sources say that these also cause a decrease in sperm volume and motility.
Antidepressant medications
Various antidepressant medications can cause erectile dysfunction and difficulty completing ejaculation. They can also cause damage to sperm DNA and decreased count and motility.
Hair growth medication
Finasteride is a prostate medication that is also commonly used for male pattern baldness to stimulate hair growth. It may cause abnormal sperm parameter. In some people these are reversible, but in others, the effects can be long-lasting.
Pain medications
Certain analgesics and opioid pain medications can cause issues with sperm production and DNA fragmentation. Morphine and even some of the over-the-counter pain medications, if used for too long, can be a culprit for decreased sperm production and quality.
Anabolic steroids
Anabolic steroids used to reach fitness goals can decrease sperm production by altering hormone production and interfering with the body’s ability to make testosterone. Many fitness supplements have steroids in them, and consumers do not always realize that these can be detrimental to future fertility goals.
Overexposure to heat in the testicles
The testicles hang outside of the pelvis for a reason. They perform their functions of spermatogenesis at a few degrees lower than body temperature. Hot tubs, saunas, occupational heat, and possibly laptops can increase the temperature of the scrotum and affect sperm quality, production, and motility. Exposure to higher temperatures for extended periods can also cause damage to sperm DNA.
Prolonged sitting
Prolonged sitting doubles the risk of sperm DNA fragmentation if you sit for 50% or more of the day doing sedentary work. Getting up from your desk regularly and walking around is helpful to improve circulation and decrease heat in the testicles.
Body weight
Being overweight or underweight can disrupt your hormones and affect sperm health. People who carry extra weight are considered obese by medical standards. Obesity can lead to lower numbers on all markers on a semen analysis.
Structural issues:
Varicocele
A varicocele is an enlarged vein in the scrotum that can cause inflammation in the testicle and negatively affect sperm production and quality. A varicocele might be suspected after a semen analysis with a very low sperm count (also called oligospermia). Doctors may recommend reproductive medicine treatment options such as intrauterine insemination (IUI) or IVF with sperm retrieval or varicocele surgery. Many believe that the inflammation present may negatively impact sperm quality.
Vasectomy
A common surgical procedure called a vasectomy can be reversed successfully, though there is a slight chance of scar tissue formation which can cause difficulty conceiving after a vasectomy reversal. Most people have adequate sperm in their semen a few months to a year after the vasectomy reversal. Many people can conceive an average of 6-12 months post-reversal assuming all other factors are normal, though normal sperm production can vary.
Other issues of infertile men may include undescended testicles, cancerous and nonmalignant tumors, or infections of the mumps virus after puberty. Additionally, a problem in the hypothalamus or pituitary gland can cause hormone imbalances that can affect how sperm develop.
Genetic factors:
Klinefelter syndrome, when a male is born with two X chromosomes and one Y chromosome, cystic fibrosis, and other rare genetic variations can lead to azoospermia or infertility, though with modern reproductive technology, some people can achieve a successful pregnancy.
While this is not an exhaustive list, it’s a good place to start to understand what common factors and abnormalities could cause male infertility. The best approach is to reach out to a fertility specialist (reproductive endocrinologist), or consider a urologist to make sure you are in optimal health to start trying to conceive. No matter which health care provider you’re talking to, whether it’s your fertility specialist, urologist or mental health specialist, it’s important to be open and honest with your providers so that they can give you the best options and care. There are often alternatives for medications and treatments while you are trying to conceive so that you can still take care of yourself and get the support you need.
The good news is that sometimes male infertility can be resolved with changes to diet, medications, lifestyle, and environment. The generation cycle of sperm is around 2-3 months, which means that sperm quality can often improve in just a matter of months. There have also been huge advancements in reproductive technologies these days, so focusing your efforts on improving quality can be more important than quantity.
