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Guest Blogger, Christina Barnes RN, dives into the most common causes of Male Infertility

There is a wealth of complicated information available online about every aspect of infertility: causes, signs, testing, treatments, and so much more. If you’re one of the millions of biological men struggling with infertility, you may be wondering how all of this information applies to you specifically. You’ve heard that radiation can cause infertility, so are those x-rays from your broken arm last year the reason you’re struggling to conceive? Why does it matter how much body hair you have; does this really have anything to do with fertility? You only take natural, holistic supplements so surely those aren’t affecting your sperm, right?

I discussed these issues and more with Michelle Ottey, Ph.D., Fairfax Cryobank’s Laboratory Director. Dr. Ottey is a certified High Complexity Clinical Lab Director with expertise in the field of Andrology. In simpler terms, that means she holds a very high-level certification and has extensive knowledge about male reproductive health. To help answer some of those earlier questions and hear what Dr. Ottey has to say, read on for the most common causes of male infertility:

What are the most common causes of male infertility?

• Undescended Testicles (Cryptorchidism): This condition occurs in childhood when the testicles do not descend or “come down” as they are supposed to. Individuals who have a history of this may have lower sperm counts, poorer quality sperm, and lower fertility rates. The effects of this condition on fertility may be preventable or reversible through childhood surgery to correct the undescended testicles.
• Retrograde Ejaculation: This occurs when the semen enters the bladder during orgasm, rather than exiting through the penis. Retrograde ejaculation can be caused by spinal cord disease or injury, diabetes, prostate issues, and medications.
• Varicocele: A varicocele occurs when the veins that drain blood from the testicles become swollen. The cause of varicocele is unknown, but they are reversible. Left-sided varicoceles are 10 times more common than right-sided ones because of the differences in drainage between the right and left testicles.
• Hormone Imbalances: Any condition that causes an imbalance in hormones related to the reproductive organs can cause infertility. Examples of hormone imbalances causing male infertility include excess estrogen or not enough testosterone. Medications like long-term steroid use can cause low testosterone, while different tumors or injuries can affect the parts of the brain or reproductive organs that produce various hormones. Your healthcare provider can test your hormone levels via a blood sample. Decreased body or facial hair may be a sign of a hormone imbalance.
• Infections: Sexually transmitted diseases, such as gonorrhea and chlamydia, can cause swelling and scarring in the urethra or epididymis. Dr. Ottey emphasizes that this can lead to permanent damage and long-term problems with fertility. Mumps can cause male infertility through damage to the sperm and blood supply. “Increased body temperatures can cause temporary issues with sperm quality,” says Dr. Ottey. Different illnesses can cause increased body temperatures and fevers, but fortunately issues with sperm quality generally resolve once the temperature goes back to normal.
• Anti-Sperm Antibodies: Antibodies are cells produced by your immune system to attack infections. Some individuals have antibodies in their blood or their semen that attack sperm, essentially killing the sperm cells.
• Structural Issues Affecting Sperm Transport: Inside the male reproductive system, sperm moves from the testicle through the epididymis to the vas deferens, and then into the urethra. This system is a series of narrow channels; the epididymis is a coiled tube, and the vas deferens is a tiny muscular tube. Abnormalities at any of these sites can cause issues that block the transport of sperm or semen. “If there are issues that block the transport of the sperm or components of the semen, this can lead to infertility,” says, Dr. Ottey.
• Chromosomal Disorders: Infertility is associated with certain genetic disorders, such as Klinefelter syndrome, Cystic Fibrosis, Kallman syndrome, and Kartagener syndrome. These disorders are present at birth, and the reasons for infertility differ depending on the disorder.
• Medications: “Many medications can negatively affect sperm production or sperm motility,” says Dr. Ottey. These include both prescription and over-the-counter medications, including supplements and natural remedies, so be sure to tell your healthcare provider about any and all medications you take if you have concerns about infertility. Some of the most notable medications affecting fertility include chemotherapies, antiandrogens (testosterone blockers), ketoconazole (an antifungal), and cimetidine (a combination of antihistamine and antacid).
• Tumors: There are two general types of tumors that can affect male fertility: tumors located in the male reproductive system (for example, in the testicle) and tumors located outside of the male reproductive system (for example, in the pituitary gland in the brain). Tumors in the male reproductive system can damage the cells that create, store and transport sperm and semen. Tumors in other parts of the body can affect the body’s overall hormone balance, which can lead to a decrease in fertility.
• Environmental Causes: Well-known environmental causes of male infertility include the pesticide dibromochloropropane, lead, cadmium, and mercury. There is some evidence that smoking tobacco as an adult may decrease sperm quantity and quality, and exposure to tobacco smoke as a fetus may negatively affect sperm production once that fetus is an adult.
• Radiation: Radiation impairs the body’s ability to create sperm, with very high doses of radiation above 6,000 mSv possibly causing irreversible infertility. Doses as low as 150 mSv may temporarily suppress sperm creation, with a return to normal function after a period of time. For reference, here is the radiation dose for some common x-ray and CT tests as published by the American College of Radiology:
  • Hand x-ray: 0.001 mSv
  • Dental x-ray: 0.005 mSv
  • Spine x-ray: 1.5 mSv
  • Spinal CT: 6 mSv
  • Chest CT: 7 mSv
  • Abdomen and Pelvis CT: 10 mSv

While this list may seem daunting, there are some things you can do right now to improve the health of your sperm and your fertility. “All of the advice you’d give to someone to live a healthy lifestyle applies to healthy semen samples,” says Dr. Ottey. “Sleep, eat well with lots of leafy greens, decrease stress, don’t smoke, don’t drink alcohol in excess, exercise, and maintain a healthy weight.” She also suggests avoiding biking or anything that raises testicular temperatures. “If someone is experiencing any type of infertility, know that you are not alone,” she says. “Though many choose not to speak openly about fertility struggles, many people experience it. 30% of those trying to build their families experience some form of infertility. Be your own advocate, speak up, ask questions, and make sure you are receiving the best healthcare possible from your medical providers.”

** I would like to note that I use the term “male” infertility to refer to individuals with biologically male reproductive systems. I recognize that not everyone who is biologically male identifies as such, and I hope all interested individuals will find this article to be helpful.

Curious to learn more about how to use a sperm donor when dealing with male infertility? Visit Fairfax Cryobank’s Couples Facing Infertility resource page.