There are many different causes of male infertility. Some conditions are reversible, while others may require fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Determining the cause is important, especially when there are severe abnormalities of sperm number or function. You may need to be seen by your primary care physician or a urologist for a complete physical examination, to make sure that there is not a testicular tumor responsible for the low sperm count.
The following are some of the more common causes of male infertility:
- Varicocele – dilation of the vein surrounding the spermatic cord can affect sperm number and motility. A large varicocele may be noticeable and cause pain or swelling. Surgery can remove a varicocele but does not always improve the sperm count, and treatment with insemination (IUI) may be as effective.
- Medications – a small number of medications are known to lower sperm counts; for many other medications there is less known about their effects on fertility. The decision to stop or change a medication should be made after careful consideration of the possible effects upon your health.
- Chemotherapy and Radiation – treatment of cancer, either as a child or adult, can result in low sperm counts or even sterility.
- Heat – exposure to extremes of heat, either through your job or through frequent use of hot tubs or saunas, can lower your sperm count.
- Infection – mumps is an infection that can lower your sperm count if you get it as a teenager or adults. Epididymitis, a painful infection of the scrotum, can cause scarring of the sperm duct and blockage of sperm. Infections of the prostate may produce inflammatory cells that show up in the sperm and make it harder to conceive.
- Congenital absence of the vas deferens – in this condition the tubes that carry the sperm out of the testicles are absent from birth. This is often associated with cystic fibrosis, a serious disease of the lungs, and genetic testing of both the male and his partner are recommended. Because sperm production is normal, IVF is a very successful treatment, because the sperm are taken directly from the testicles by a biopsy performed in the IVF lab.