The cause of a couple’s infertility can be due to problems that affect the man or the woman, or both. If the problems are related to the man they are called male factor infertility.

Male factor infertility is related to problems that affect a man’s ability to achieve a pregnancy with his partner. These problems might be a problem with sperm, a problem with sexual intercourse, or a general health problem for the man that reduces fertility.

The most common cause of infertility in men is relating to sperm. Fertility problems occur when either not enough sperm is being produced, or the sperm is of poor quality. Often the sperm’s swimming ability is low and a lack of swimming means that the sperm will be unable to reach the egg. Sperms that are abnormally shaped will also be a lot less likely to make a baby.

A simple sperm test performed in a fertility clinic will often show up a sperm problem. Problems with sperm will require some tests to see whether any underlying cause might be found. Both medications and illnesses can cause sperm problems and these will be evaluated when you attend for a sperm test. For many men, the cause cannot be found with the tests currently available worldwide. In these situations medications and drugs will rarely achieve a pregnancy. Treatments often used are IUI and IVF with sperm injection (ICSI).

For men with very low sperm counts (less than 5 million sperm per ml) or no sperms at all (azoospermia) a genetic blood test might reveal the problem. The latest figures suggest that one of every 20 men with these severe problems will have a genetic reason causing the sperm problem.

Sometimes the cause of sperm problems is due to a blockage or absence of the tubes which carry sperm from where they are produced in the testicles. If tests show that hormone levels are normal then a simple surgical procedure can be used to find sperm that are being made in the testicles, but cannot get out naturally. A range of surgical sperm retrieval procedures are available (MESA, TESA TESE).

Testosterone, androgens and low sperm levels

Long term use of Anabolic Steroids and androgens will reduce the number of sperm produced and affect their motility (swimming). This is why men on testosterone replacement therapy (gel, patches & injections) often have a low sperm count and infertility. Stopping these treatments will often lead to a higher sperm level and a return to normal fertility levels. Other drugs, such as Proviron, are weak androgen drugs and are known to have the same effect on generally lowering fertility levels for men. Sadly they are sometimes prescribed with the opposite intentions, to boost fertility, when doctors or pharmacists are out-of-date with international medical best practice.

Cancer treatments and preserving fertility

The drugs involved with Chemotherapy can severely reduce sperm production, however advances in sperm freezing of course now mean that if you have to undertake a course of chemotherapy you should be offered the option the of freezing sperm in advance of your treatment.