5 causes of male infertility

Examples of teratozoospermia or abnormal sperm (in red), with a normal sperm (in blue) for comparison. — 123rf.com

Infertility is suspected when a couple is unable to successfully conceive after approximately one year of unprotected sexual intercourse.

While there are many causes of infertility in both genders, over a third of them stem from the male – primarily due to problems with sperm production or delivery.

In no particular order, here are the top five causes of male infertility:

1. Sperm disorders

A healthy amount of good quality sperm is necessary in order to have the best chance of conceiving.

Sperm disorders include:

• Oligospermia – Low sperm count, defined as fewer than 15 million sperm per millilitre of semen.
• Azoospermia – No measurable amount of sperm is present in the semen to fertilise your partner’s egg, making natural conception impossible.
• Poor motility – A large proportion of sperm are unable to swim properly or even move at all, making it unlikely they can reach and penetrate your partner’s egg.
• Abnormal morphology – Sperm are immature or abnormally-shaped, and may not live long enough to fertilise the egg.

Factors that can affect the health of sperm include:

• Environmental and lifestyle factors – For example, smoking, excessive alcohol intake, illicit drugs or steroid use, or exposure to toxins.
• Hormonal factors – Diseases of the pituitary gland or testosterone deficiency can affect sperm production.
• Testicular infection – Especially from the mumps virus or tuberculosis during childhood.
• Chronic diseases – For example, kidney failure can affect sperm production.
• Genetic diseases – For example, cystic fibrosis or haemochromatosis, which can affect sperm production or transport.

2. Erectile dysfunction (ED)

ED is an inability to obtain or maintain a good erection.

While ED is a fairly common problem that can happen to men at any age, it is more common from middle age onwards.

It can stem from:

• Hypertension (high blood pressure)
• Diabetes
• Atherosclerosis (restricted blood flow due to plaque build-up)
• Hormonal or pituitary gland issues
• Phimosis (tight foreskin)
• Benign prostatic hyperplasia (BPH) - abnormal prostate enlargement
• Lifestyle factors such as smoking, heavy alcohol and/or drug use
• Stress or mental health conditions such as depression and anxiety
• Side effects of certain medications to treat hypertension or hair loss

3. Varicocele

Varicocele is the enlargement of veins in the testicles, caused by abnormal backflow of blood.

Exactly how this condition can cause infertility is unknown, but studies suggest that it could be related to warmer temperatures from the increased blood flow, which may be suboptimal for sperm production.

Approximately 16% of men may have a varicocele.

4. Retrograde ejaculation

This condition occurs when the semen enters the bladder instead of emerging through the penis during orgasm, due to the muscles of the bladder neck not tightening properly.

This can happen due to previous surgery, certain medications or nerve damage caused by medical conditions.

Men with this condition may experience dry orgasms, where very little or no semen is ejaculated from the penis.

Urine may also appear cloudy after an orgasm.

5. Sexually-transmitted diseases (STDs)

STDs such as chlamydia, gonorrhoea and HIV (Human Immunodeficiency Virus), can lead to inflammation of the epididymis or testicles if left untreated for a prolonged period of time.

This interferes with sperm production and health.

Chronic inflammation of these structures may lead to permanent scarring that blocks the passage of the sperm.

Dr Edwin Ong is a general practitioner (GP) in Singapore. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.