Dealing with Male Factor Infertility

July 29, 2022

Learn more about what male factor infertility is and the steps to take for treatment and moving forward.

It’s an exciting time when you and your partner decide you want to have a baby. Some couples conceive right away, while others take a bit longer—but when the months start stretching on, it’s time to consider whether infertility might be an issue. 

What is male factor infertility, and who gets it?

Male factor infertility is more common than many people assume. In fact, it’s an issue in at least half of all cases of infertility. While fertility treatments often focus on the birthing partner, there are also a wide array of treatments, reproductive technologies, and lifestyle interventions that can help couples dealing with male factor infertility to conceive. 

Male factor infertility can happen to any man, but there are risk factors, like obesity, being 40 or older, drinking alcohol, and smoking tobacco or marijuana. Being exposed to radiation, therapeutic testosterone, anabolic steroids, or environmental toxins can also play a role, as can certain medications, a history of undescended testicles or varicoceles (widened scrotal veins), and frequent use of heat, as in a sauna or steam room. 

Different types of male factor infertility 

Male fertility requires normal function in the hypothalamus, the pituitary gland, and at least one testicle. Once sperm are produced in the testicles, they must travel through tubes (which are known as “vas deferens”) to mix with semen in preparation for ejaculation. To conceive a pregnancy, there must be enough sperm in the semen (this is referred to as “sperm count”), those sperm must have a healthy shape (this is known as “morphology”), and the sperm must have the ability to move at an effective speed (this is called “motility”). If there is an issue with any one of these elements of the process, the result will often be male factor infertility. 

In 30-40% of male factor infertility cases, the problem is in the testes. Issues can range from physical injury, exposure to chemotherapy or radiation, or genetic conditions like Klinefelter syndrome.  In 10-20% of cases, there is a blockage in the vas deferens, which carry sperm from the testes during ejaculation. This can be caused by a previous infection, an unsuccessful vasectomy reversal, or, occasionally, a genetic lack of vas deferens. 1-2% of cases are due to problems with the pituitary gland or hypothalamus, and nearly half of all cases have no identifiable cause. 

Testing and treatment

If you suspect infertility might be an issue, it’s a great idea to see a doctor for a fertility workup. A urologist or a reproductive endocrinologist is the best kind of specialist to see, but if you have a trusted GP or internist, you can start there. A fertility workup typically includes a history, physical exam, blood testing, and semen analysis, and can often give you concrete answers about whether you’re experiencing infertility, what the cause may be, and what potential treatments are available.  

Treatments for male factor infertility depend primarily on what the cause is and on how invasive and expensive a procedure you’re open to. If you’re dealing with a blockage in the vas deferens, or with the enlarged scrotal veins known as varicoceles, surgery can sometimes correct the issue. Hormonal treatment can treat hypothalamic or pituitary deficiencies. When motility or sperm count is the suspected cause of infertility, doctors can concentrate sperm from a sample to then use for intrauterine insemination in the birthing partner. In cases of “testicular failure” (when the testicles are either damaged or abnormal and thus cannot produce sufficient sperm), doctors can use a procedure called TESE (“testicular extraction of sperm”) to extract sperm directly from the testicles. The sperm is then used for intra-cytoplasmic sperm injection, a process where a doctor injects a single sperm into a single egg prior to implanting it into the birthing partner. 

What if treatment doesn’t work?

Sometimes, there isn’t a known cause for male factor infertility, and thus there isn’t a good treatment option. Other times, the proposed treatment is more invasive or unaffordable than you might be comfortable with. A couple may simply decide that treating their male factor infertility isn’t a high priority for them. In these cases, donor sperm is an amazing option to consider—it can, in some cases, allow a couple to conceive with minimal waiting, a low level of expense and intervention, and a much less medicalized experience of conception. 

As with any form of infertility, male factor infertility can be difficult to deal with. Feelings of loss, grief, shame, and inadequacy are unfortunately common, and because men are socialized to be less open about their feelings, it can be challenging to process the experience of infertility in an emotionally healthy way. Private therapy or support groups like the ones facilitated by Resolve: The National Infertility Association can be strong sources of support. 

The takeaway

If you and your partner are dealing with male factor infertility, know that you are not alone. Modern fertility science is amazing, and there is a huge array of treatment and support options out there to help you create the family of your dreams. 

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