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Houston Fertility Journal

    5 Common Signs of Infertility in Men

    May 18, 2018 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    Speaking with your partner about infertility is, no doubt, a sensitive topic. A really difficult part of it is that infertility could exist within either one of you, or even both of you.

    Here are a few statistics on this:

    Therefore, it is equally as necessary for both partners to consider themselves when discussing treatment. If the two of you have started to look for any signs of infertility, there are some telling indicators that could clue you in to the root of the problem.

    Many couples experience no symptoms at all. Yet, they also may not have considered that certain physical conditions could be indicators of infertility. Here are 5 common signs of infertility in men to look out for.

    #1 - Pain or Swelling in the Testicles

    There could be many different explanations for swelling and pain in the testicular region. The pain may be in one spot or in a more generalized region. No matter the case, it is important that those experiencing these symptoms seek medical attention. Some of the following conditions are considered a medical emergency and it is better to be sure that you are in the clear rather than to assume.

    Common causes of testicular swelling include:

    Testicular torsion. This is a condition where the testicle has twisted inside of the scrotum. When this happens it causes an interruption of blood flow to the testicle. Without bloody supply the testicle can experience failure in the tissue.

    Epididymitis (testicle infection). In most cases, men develop epididymitis from a bacterial infection. This can occur at any age but it is most common between ages 20 and 39. The infection may lead to fever, penile discharge, and blood in the urine. A firm tube, called the epididymis, lies on the back surface of each testicle and can become inflamed which may also be the cause of the swelling in the testicle.

    Hydrocele. This is a build up of fluid around the testicle that is commonly caused by inflammation or injury to the scrotum. It is usually not harmful or painful and should not get in the way of a male’s ability to conceive. This could be a reason for the swelling, but medical attention is still recommended to rule out other possibilities.

    Hernia. A hernia can be the cause of swelling and pain in the testicular region and may require surgery in order to fix the damaged area. It is uncommon for an inguinal hernia to cause infertility, but there are certain rare instances where it could play a role. If the hernia is left untreated for too long it could damage a man’s vas deferens (the tube that sperm travels through).

    Varicocele. Varicoceles are veins that have become enlarged in the scrotum. They are known for affecting 40 out of 100 men with known infertility. Surgery can be done to repair the veins and improve the male’s fertility factor.

    #2 - Altered Sexual Desire

    When a man experiences extreme changes in virility, this could indicate issues in his hormonal health which is linked to certain causes of infertility in men.

    Common causes of hormonal problems include:

    Pituitary tumors. These tumors are benign because they do not spread to other parts of the body. Still, reproductive issues can and do stem from them as most present symptoms of androgen deficiency and even infertility.

    Congenital lack of LH/FSH. Also referred to as male hypogonadism, it is responsible for 1-2% of male infertility. It may be congenital or acquired from aging, disease, drugs, or other factors. Diagnosis of its existence is confirmed by the analysis of hormone levels.


    Anabolic steroid abuse. The abuse of steroids can cause a male’s infertility to decline during use and possibly have lasting effects if the abuse goes on for long enough. However, fertility can normally be restored with abstinence from androgens and gonadotropin injections. It is important to note that there are many drugs that can alter a male’s hormonal health and steroids should be used with caution/only through prescription from a medical professional.

    #3 - Erectile Dysfunction

    Studies have shown that the presence of sexual dysfunction exists in about 20-25% of couples struggling with infertility. These issues are also commonly linked to hormonal imbalances like those listed above.

    In addition, common causes of erectile dysfunction are:

    Venous leak. When the veins that normally compress during an erection do not compress fully it can cause the erection to go away or not last long. This is usually the result of injury or disease.

    Neurovascular function. An erection cannot occur if the nerves don’t signal the blood vessels to push blood into the penis. These issues are commonly the result of medications or conditions like diabetes, arteriosclerosis (the hardening of the arteries), and a spinal cord injury.

    Psychological factors. 10-15% of erectile dysfunction is due to feelings of guilt associated with sex, depression, anxiety, and stress.

    Erectile dysfunction could stem from easily fixed or more serious internal complications. It is possible to approach this issue by considering:

    • Switching medications
    • Adjusting to a healthier diet and exercising more
    • Quitting smoking
    • Not using recreational drugs
    • Considering counseling
    • Speaking to a doctor about other possible causes if you are in good mental and physical health

    #4 - Issues With Ejaculation and Sperm Health

    If a man is experiencing difficulty ejaculating it could indicate an issue involving sperm production or other physical dysfunctions. Without the ability to produce healthy sperm:

    • the sperm may not be carried into the semen and continue on to be ejaculated from the penis
    • there may not be enough sperm within the semen
    • the sperm may not be functional enough to travel well and penetrate the woman’s egg


    Sperm production problems include:

    • Chromosomal or genetic causes. Right from birth, the chromosomes may not be coded correctly. For instance, the male may be born with the wrong combination or amount of chromosomes. Any number of genetic problems can have an affect on fertility and would need to be treated.
    • Undescended testes. When the testes fail to descend at birth it can cause infertility and also eventually result in torsion, hernia, and testicular cancer. Boy’s testes usually descend by the time he reaches 9 months but 1 in 20 unfortunately do not descend at all.
    • Torsion. As mentioned above, torsion is when the testes become twisted inside of the scrotum. This must be treated with surgical intervention or it can lead to permanent infertility.
    • Varicocele. Also mentioned above, this is when the veins flowing from the abdomen into the scrotum are enlarged. This is one of the most common causes of infertility in men, affecting the production and quality of sperm in 40% of males. However, this is also the most commonly reversible infertility problem in males.
    • Medicines and chemicals. Certain drugs are known to cause male infertility. These drugs usually include calcium channel blockers, cimetidine, nitrofurantoin, and chemotherapy agents. Certain antibiotics, such as nitrofurantoin, can lower the sperm count by disrupting the production process. Make sure to ask your doctor about effects on fertility whenever a medication is prescribed.
    • Radiation damage. Exposure to radiation can reduce sperm production but it will often return to normal. High doses of radiation, however, can cause be permanent damage.

    Blockage of sperm transport can be the cause of:

    • infection
    • prostate-related problems
    • absence of vas deferens
    • vasectomy

    Furthermore, ejaculation issues could be the result of:

    • Retrograde. This is when the semen goes directly into the bladder instead of exiting out of the penis. It does not present any physical harm to the man, but it can make it difficult to conceive.
    • Delayed ejaculation. About 3% of men struggle with delayed ejaculation. Also some men are not able to reach orgasm at all during intercourse. This is often to due anxiety, depression, or medications prescribed for such issues.
    • Erectile dysfunction. As discussed above, erectile dysfunction can be the cause of greater or lesser serious health conditions.
    • Spinal cord injury. Depending on the extent of the injury, it can be known to lead to causing retrograde ejaculation or difficulties maintaining an erection.
    • Prostate surgery. Natural fertility is generally unlikely after one undergoes prostate surgery, though assisted methods are known to be recommended and quite successful.
    • Nerve damage. As mentioned earlier, nerve dysfunction can get in the way of normal reproductive function as the nerves are not able to signal the body to respond in it’s usual manner.

    #5 - Small, Firm Testicles

    The health and quality of the males sperm depends greatly on the condition of the testicles. The size is not necessarily the issues, but rather what is occurring within the testicles that could be causing them to become constricted and firm. A fertility specialist will be able to properly assess the health of the testicles and whether or not they are able to function correctly and successfully during sexual reproduction.

    Male Infertility Testing


    In order to check for the presence of possible infertility in a man, specialists will most commonly begin with semen analysis. In order to do so they will:

    • Collect the sperm into a specimen jar and and bring it to a lab where it will be examined under a microscope to evaluate the shape, appearance, and mobility of the sperm.
    • The technician will also be checking the sperm count and concentration to see if it is above or below 20 million sperm cells per milliliter of ejaculation fluid.
    • If the sperm count is found to be low, the fertility specialist will then probably want to test the testosterone, FSH, LH and prolactin levels for clues as to why this is the case.
    • Urinalysis can be used to check the white blood cells for any existing infection. Urine can also be screened for any presence of sperm in the urine which could be an indicator of retrograde ejaculation.
    • If the male’s physical exam and sperm analysis, along with medical history, are found to be normal, the specialist will usually shift their focus to the female partner.
    In some cases, results may require further laboratory testing or semen analysis, such as:
    • Sperm agglutination: checking to see if the sperm are clumping together by use of a microscope.
    • Sperm penetration testing: a lab test that analyzes the sperm’s ability to penetrate the egg - this test is rarely used as it requires the use of animal eggs for testing.
    • Hemizona assay: a lab test using a non usable human egg to test penetration.
    • Acrosome reaction: a lab test analyzing whether or not the sperm heads are able to go through chemical changes necessary to dissolve the outer shell of the egg
    • Testicular biopsy: when a small piece of tissue is removed from the tubules in the tests to check for sperm health and production.
    • Vasography: an x-ray exam that determines if there is blockage or leakage of sperm in the vas deferens.
    • Ultrasonography: an exam used to check for any damage of blockages in the reproductive tract.

    Seeking Infertility Treatment

    If you and your partner have not been able to conceive after trying for a year, there is most likely something that is hindering one or the both of you. Even if you haven’t noticed any obvious symptoms or signs indicating infertility, you should still speak with a specialist. Talking with an expert will help you to understand your options better and if reproductive assistance is something that could be necessary for you.

    You can research a lot of information on the internet, but a real doctor is the only one that can give you the answers that you need. If you would like to speak with a specialist, contact one of our Texas Fertility Center Locations today.

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    Topics: Male Fertility Testing, Male Fertility

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