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JAMA Patient Page
May 5, 2015

Male Infertility

JAMA. 2015;313(17):1770. doi:10.1001/jama.2015.3222

Infertility is often thought of as a problem only among women; men are often overlooked.

What Is Infertility?

According to the American Society for Reproductive Medicine, infertility is when couples cannot become pregnant after 1 year of trying. In about half of couples with infertility, a problem with male infertility affects the couple’s ability to conceive a pregnancy.

To be fertile, men must have enough sperm in their semen, and these sperm must be healthy. Sperm production is driven by hormones. In the brain, the pituitary gland makes 2 important hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Both of these hormones affect the testicle, an important organ for fertility. Sperm is produced in the testicle and travels through very small ducts (the epididymis and vas deferens) before it is released in semen.

Causes

Some men have low amounts of sperm, or no sperm, in their semen. This can be caused by either a blockage of sperm delivery or problems with sperm production.

  • About 20% of infertile men have hormone abnormalities. Any problems with the body making LH, FSH, or testosterone can lead to infertility.

  • Various genetic abnormalities can also cause infertility.

  • Another condition that can lower sperm production is varicoceles, which are enlarged veins in the scrotum.

Unlike in women, increasing age alone should not cause male infertility.

Tests to Check for Male Infertility

When treating a couple with infertility, both the man and the woman should be evaluated. The man should be evaluated by a male infertility specialist, who should perform a thorough medical history and physical examination. Blood tests for hormone levels may be done. Often, 2 or more semen analysis tests are performed, which provide information about sperm quantity, movement, and shape.

What to Do Before Seeing a Specialist

  • A healthy diet and regular exercise are the best way to maintain overall health.

  • Quitting smoking, reducing alcohol use, and not using drugs such as marijuana and cocaine can improve male fertility.

  • Avoid heat exposure (such as hot tubs or saunas), which can lower sperm production for up to 3 months.

Treatments

Sometimes men can be treated with medications to improve their hormone levels and increase sperm production. Use of testosterone medications and anabolic steroids should be avoided; these can affect normal sperm production.

Surgery, with or without the use of an operating microscope (microsurgery), can be performed to correct a varicocele. Microsurgery is also used to successfully repair certain types of blockage.

If no sperm is present in the semen, sperm can sometimes be obtained from the testicle with surgery, then transferred directly into the egg through a process called in vitro fertilization.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish. A Patient Page on infertility in women was published in the January 20, 2015, issue.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Brannigan reports grants from AbbVie Inc. No other disclosures were reported.

Sources: American Urological Association. The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement. Linthicum, MD: American Urological Association Education and Research Inc; 2010.

Topic: Reproductive System

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