Male Infertility

Male fertility issues play a role in about 50 percent of all couples facing fertility problems. A physical exam will identify most of these.

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Infertility is a common condition that affects the reproductive system and prevents a woman from getting pregnant. If a couple has unprotected sex for a year and is unable to achieve pregnancy, infertility is a likely cause.

Male infertility is the main or contributing factor in approximately half of couples who have trouble getting pregnant. Many of the causes of male infertility are treatable with the right care plan.

University of Iowa Health Care offers the most advanced and comprehensive care available to determine and treat the causes of infertility. Our team includes the state's only fellowship-trained urologist with a specialized focus in male infertility, with decades of experience helping couples have babies.

A comprehensive, team approach to treat infertility

Infertility affects couples as a pair, so we include you and your partner in our care plan. Our urologists work closely with a team of experts that includes reproductive endocrinologists, embryologists, andrologists, and genetic counselors dedicated to evaluating and improving fertility.

Together, your care team will help you make informed decisions about your treatment options and fertility goals.

This collaboration allows us to personalize a care plan for you. It also makes it possible for our specialists to provide testing or treatments for you and your partner at the same time, with the option to schedule appointments on the same day.

Advanced testing for male infertility

UI Health Care is home to a state-of-the-art andrology lab that focuses exclusively on reproductive testing for fertility issues in men to help diagnose the causes of infertility. Our lab offers motile sperm isolation—isolating sperm for procedures like in vitro fertilization (IVF) or intrauterine insemination (IUI)—and semen cryopreservation to preserve your sperm for future use.

Symptoms of male infertility

Most people who experience male infertility do not have obvious symptoms. Not being able to conceive a child may be the first sign you notice.

If you have an underlying condition, such as a hormone imbalance or anatomical irregularity, symptoms could include:

Difficulty ejaculating or ejaculating small amounts of semen
Reduced sexual desire
Difficulty maintaining an erection
Pain or swelling in the testicle area
Decreased facial or body hair
Low sperm count
Abnormal breast growth (gynecomastia)

Causes of male infertility

To get your partner pregnant, your sperm must be healthy, abundant, functional, and able to be transported successfully. Because the process is complex, there are many medical, environmental, and lifestyle-related issues that can prevent the process from being successful.

Medical conditions

Varicocele: A dilation of the veins that drain the testicles, varicocele is a common condition for men with infertility and can be corrected with treatment. While this condition does not always cause infertility, it has been known to reduce sperm quality and quantity.
Retrograde ejaculation: A condition that causes the semen to enter the bladder during orgasm instead of exiting from the tip of the penis, retrograde ejaculation can be caused by various health conditions, injuries, medications, or urological surgery.
Undescended testicles: If one or both testicles do not descend into the scrotum during fetal development, decreased fertility is possible.
Blockages of the tubes that carry semen: Injury, surgery, scar tissue, infections, or an inherited condition may cause a blockage in one of the tubes that carry semen.
Chromosome genetic disorders: Inherited disorders like cystic fibrosis, Klinefelter’s syndrome, and Kallmann’s syndrome can affect the development of reproductive organs, decreasing fertility.
Hypospadias: When the opening of the urethra is not at the tip of the penis, depositing semen for pregnancy is difficult.
Erectile dysfunction: This condition refers to not being able to obtain or maintain an erection long enough to properly deposit semen for pregnancy.
Infection: Infections, including sexually transmitted diseases, can cause inflammation, scarring, or damage to your reproductive organs that can affect sperm production and health.
Cancers: Testicular cancer is not the only cancer that can affect sperm production. Unrelated cancers like lymphoma can also impact sperm production.
Hormone imbalances: Disorders that cause problems with hormone production or distribution, such as low testosterone, can affect fertility.
Medications: Some medications can affect sperm production, including chemotherapies and testosterone replacement medications.
Surgeries: Vasectomy and other surgeries on your reproductive organs—including cancer, hernia, or prostate surgeries—might cause problems with sperm transport.

Health and lifestyle factors

Drug use: Anabolic steroids, marijuana, and cocaine can cause issues with the quality and quantity of your sperm.
Smoking: Tobacco use can cause lower sperm production.
Alcohol use: Alcohol consumption can cause erectile dysfunction, low testosterone, and liver disease, all of which can affect fertility.
Weight: Obesity can be a sign of hormone disorders that can cause infertility.

Environmental exposure

Chemical: Exposure to certain industrial chemicals and toxins has been known to affect sperm production.
Heavy metal: Some heavy metals, such as lead, can cause infertility.
Radiation/X-rays: Radiation exposure can reduce sperm production, sometimes permanently.
Heat: Prolonged exposure to heat may impair sperm production.

Diagnostic testing for male infertility

An infertility diagnosis consists of three main elements:

Medical interview: We conduct a thorough review of your medical history for any current medical conditions, medication use, lifestyle factors, or anatomical irregularities that could be affecting your fertility.
Physical examination: We provide a thorough examination for any signs or symptoms that might indicate a medical condition.
Semen analysis: We perform a test to measure the quality and quantity of your semen and sperm. Because sperm count and motility can fluctuate in a fertile man, we usually perform two semen analyses, a month or so apart, to verify results.

Based on the results of these three elements, we may also consider additional tests such as ultrasound and urine or blood (hormone or genetic) tests. Your provider will discuss these additional tests with you, if necessary.

Treatment for male infertility

Not every diagnosis of infertility has a clear or exact cause, but your doctor may still be able to help improve your chances of conceiving. Depending on your reproductive goals and diagnosis, you may consider:

Surgical options: Some conditions that cause infertility, such as varicoceles and blockages in the vas deferens, can be repaired with surgery. You may also be able to get your vasectomy reversed.
Treating underlying conditions or behaviors: If your infertility is the result of an infection or certain kinds of lifestyle or environmental factors, your provider can help treat your issue to restore fertility.
Hormone management and treatment: If your infertility is caused by a hormone disorder or use of hormones, your provider can recommend medications and treatment plans to restore hormone balance.

Assisted reproductive technology (ART): Depending on availability of sperm and its quantity and quality, either intrauterine inseminations or in vitro fertilization could be considered. If needed, sperm could be surgically retrieved for in vitro fertilization.