A woman’s inability to conceive a child can be stressful and frustrating for the woman in particular usually because it is common perception that she is at fault. But in a number of cases, the man may be unable to get the woman pregnant due to one cause or another. Approximately one in four couples is not able to conceive a child even though there has been frequent, unprotected sexual intercourse for a year or longer. In about half of these cases, male factor infertility plays a role.

The main sign of male or female infertility is often inability of a couple to conceive a child. There may be no other obvious signs or symptoms to point at the man, but in some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance or a condition that blocks the passage of sperm may be the cause. 

Male infertility is due to a number of factors including low sperm production, misshapen or immobile sperm, or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors are part of the problem.  

Common male infertility signs and symptoms may include problems with sexual function such as difficulty with ejaculation or difficulty maintaining an erection, pain, swelling or a lump in the testicle area.  Another pointer is having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate).

It is time to see the doctor if as a couple, you are unable to conceive after a year of regular, unprotected sexual intercourse. Go to the doctor if your partner cannot have an erection or is affected by ejaculation problems, low sex drive, or other problems with sexual function. Symptoms such as pain, discomfort, a lump or swelling in the testicle area are also indicators of an underlying problem.  

Take your partner along. For infertility, your partner may also need tests to see whether she has any fertility problems that could be preventing pregnancy. It’s also good to have your partner along to help keep track of any instructions your doctor gives you or to ask questions you may not think of. Male fertility is a complex process.

For a man to get a woman pregnant, the following must occur. The man must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of his testicles must be functioning correctly, and his body must produce testosterone and other hormones to trigger and maintain sperm production. Then, it is important for sperm to be carried into the semen.

A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate. Sperm must be shaped correctly and able to move. If the movement (motility) or shape (morphology) is abnormal, the sperm may not be able to reach or penetrate the egg.

Problems with male fertility can be caused by health issues and medical treatments. For instance, a varicocele, which is a swelling of the veins that drain the testicle. It is commonly associated with male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm.

Infections like some sexually transmitted infections, including chlamydia and gonorrhea are significant. Inflammation of the prostate and testicles due to mumps are also indicated. A condition known as retrograde ejaculation that occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis can cause male infertility. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.

Health, lifestyle and other causes play a role. Use of cocaine or marijuana may temporarily reduce the number and quality of sperm as well. It is known that drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. At the same time, certain occupations can increase risk of infertility, including those associated with extended use of computers or video display monitors, shift work, and work-related stress. Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.

Many infertile couples have more than one cause of infertility, so it’s likely you will both need to see a doctor. It may take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. Infertility tests can be expensive and may not be covered by insurance. General physical examination and medical history includes examination of the genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility.

Fertility can be improved by either correcting an underlying problem or trying treatments that seem like they may be helpful. Often, an exact cause of infertility can’t be identified. Even if an exact cause isn’t clear, the doctor may be able to recommend treatments that work. In all cases of infertility, the female partner also will need to be checked and may need treatment. In some cases, treatment of the female partner may help compensate for male fertility problems.

Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.  Assisted reproductive technology (ART) treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes.

Steps that can be taken at home to increase chances of achieving pregnancy abound. One is to increase frequency of sex. Having sexual intercourse every other day around the time of ovulation increases your chances of getting pregnant. However, note that ejaculating more often may reduce your partner’s sperm count. A woman is likely to become pregnant during her ovulation which occurs in the middle of the menstrual cycle, between periods.

Coping with infertility can be difficult. It’s an issue of the unknown and you can’t predict how long it will last or what the outcome will be. Infertility isn’t necessarily solved with hard work yet the emotional burden is considerable, and plans for coping can help. So it pays to plan. Begin by setting limits. Decide in advance how many and what kind of procedures are emotionally and financially acceptable for you and your partner and determine a final limit. Fertility treatments can be expensive and often aren’t covered by insurance.

A successful pregnancy often depends on perseverance and repeated attempts.

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