Posted under Fertility Treatment by Dr. Rajeev Agarwal



What are the Factors that contribute to Male Infertility?

Causes of male subfertility


15-20 percent of couples will fail to conceive after 1 year of unprotected intercourse. A malefactor alone is thought to contribute in up to 30% of these cases. Male infertility can be due to a variety of reasons which lead to decrease count or motility of sperms or abnormal physical appearance of sperms. These can be due to defects at multiple levels starting from brain signaling pathways (pre testicular)to testes to post testicular ducts, which transport sperms to male urethra.


It is estimated that in about 50% of men with poor semen quality, no cause for this will be identified.





Conditions that act at the pretesticular level that is at the high level of brain signaling pathways tend to be hormonal in nature. They account for <1% of male factor fertility problems. It results from decreased production of FSH and LH hormones secreted from a small gland called the pituitary gland. The absence of these hormones lead to the failure of sperm formation and testosterone secretion by the testes. 


This may happen after surgery for pituitary tumors, head trauma, iron overload, other congenital genetic syndromes of reduced gonadotrophin secretion (Prader Willi syndrome), increased prolactin levels, excess steroid intake, thyroid dysfunction


Causes at the testicular level are largely irreversible but can be treated with assisted reproductive technology (ART), if sperm is retrievable surgically or through a needle procedure called TESA/TESE.  The number and quality of sperm that can be recovered, either from the ejaculate or surgically, determine the available options for assisted conception. It results from testicular failure and leads to decreased or nil sperms coupled with elevated pituitary hormone levels.

This can happen due to the following reasons:

  1. Failure of testicular descent to scrotum, 
  2. Varicocele
  3. Genetic disorders such as Y chromosome deletions, Klinefelters syndrome (47, xxy)
  4. Systemic diseases like kidney or liver failure
  5. Radiotherapy or chemotherapy

Varicoceles, a collection of dilated refluxing veins in the scrotum, are found in 11.7% of men with normal semen and 25.4% of men with abnormal semen. The exact mechanism by which a varicocele can affect fertility is not well understood but theories include increased scrotal heating and altered testicular steroid synthesis.

However, in the majority of cases (66%) the cause is unknown. 


Post-testicular cause: it maybe due to blockage of passages carrying sperms from testes towards the exterior. These can be treated with microsurgery or through IVF. Obstruction in passages transporting sperms from testes to ejaculate accounts for up to 41% of cases of azoospermia.


Causes include:

  • surgical trauma and vasectomy, 
  • infection (chlamydia, gonorrhea, tuberculosis), 

Absence of specialized ducts called vas deferens which connect the testes to the male urethra especially in cystic fibrosis


Diseases like- Diabetes mellitus, or, spinal cord injuries may also be deterrent in normal conjugal life 



Male age

paternal age of >35 years halves the chance of achieving pregnancy compared with a paternal age of <25 years. The effect of age on male fertility is more noticeable after the age of 50with studies showing a concomitant increase in adverse outcomes in the offspring.

Environmental, occupational and lifestyle factors

There is increasing evidence from epidemiological studies that occupational exposures to certain chemicals can affect semen quality. These include heat, X-rays, heavy metals (lead, mercury), glycol ethers (highly volatile compounds used as solvents)and pesticides; The exact mechanism by which these occupational substances affect male fertility remains unclear.


There is evidence that a sedentary lifestyle, most likely through elevated scrotal temperature, can affect sperm production.


Obesity causes altered semen parameters through an imbalance of reproductive hormone levels, as obese men have reduced hormone-binding proteins leading to elevated female hormone or estrogen levels. 


Steroids may induce having nil sperms by interfering with the brain signaling pathways Azoospermia caused by steroid intake may be reversed by conservative management when the drugs are discontinued, especially in non-heavy users or by the administration of human chorionic gonadotrophin and human menopausal gonadotrophin. Sperm quality tends to recover spontaneously within 4–12 months after discontinuation.

Heavy alcohol consumption:

Heavy alcohol consumption but not moderate consumption, may affect sexual and reproductive performance in a reversible fashion.

Nicotine and Drugs

Tobacco smoking and cannabis consumption have been shown to reduce semen quality. Although smokers, in general, may not experience reduced fertility, men with suboptimal semen quality may benefit from quitting smoking and this should be strongly encouraged. 

About the author

The author, Dr. Rajeev Agarwal is a Fertility Consultant at Care IVF Kolkata. For an appointment with the doctor, call +91-33-66-398-600. You can also book a Skype Consultation here.


    Leave a Comment

    Related Posts

    Assessing Tubal Damage through Tubal Patency Tests
    Understand the pathophysiology behind tubal factor infertility, what causes tubal blocks and what a ...
    Read More
    Imaging the uterus better with Saline Infusion Sonography (SIS)
    Understand how Saline Infusion Sonography helps visualise the uterine cavity better and allows detec ...
    Read More
    Folliculometry – The best way for Ovulation Tracking.
    Understand the role of follicular study in tracking follicular and endometrial growth, predicting ov ...
    Read More
    Understanding Turner Syndrome and Conception Options
    What are the conception options for people with turner syndrome? How can pe ...
    Read More
    Pre-implantation Genetic Testing for Aneuploidies (PGT-A) simplified for couples.
    PGT-A is being recommended more often these days for couples with multiple IVF failures, recurrent m ...
    Read More
    Significance of laparoscopy in managing female subfertility
    Laparoscopic surgery is often recommended for infertile women before IVF. This article will help you ...
    Read More
    6 Major Fertility Breakthroughs that have helped improve IVF outcomes
    Assisted Reproductive Technology is a constantly evolving field with research focussing on improving ...
    Read More
    Understanding Premature Ovarian Insufficiency
    What is Primary Ovarian insufficiency? what causes premature Menopause and what is the treatment app ...
    Read More
    What are the techniques of surgical sperm retrieval?
    Understand how sperms are aspirated surgically during IVF procedure and what are the different ways ...
    Read More
    What happens if you have an Ectopic Pregnancy?
    When the fertilized egg implants anywhere except the uterine lining, it is called an ectopic pregnan ...
    Read More
    What is recurrent pregnancy loss? How to improve conception chances if you have RPL?
    Understand what is recurrent pregnancy loss and why does it happen. What are the tests needed to und ...
    Read More
    Genetic counselling - read this before going for a genetic consult?
    If you are planning to see a Genetic Counselor and have questions regarding the whole genetic counse ...
    Read More
    What is the role of genetic factors contribute to recurrent pregnancy loss?
    Understand why genetics factors play an important role in infertility especially when all is well bu ...
    Read More
    Genetic testing through Microarray - Who should go for this?
    Chromosomal microarrays form the basis of Pre-Implantation genetic testing. Understand its significa ...
    Read More
    How does hydrosalpinx effect female fertility?
    Understand the condition of Hydrosalpinx, what causes it, and how it affects female fertility. How i ...
    Read More
    Renting a Womb - A Guide To Getting Started With Surrogacy
    Is surrogacy for all couples? Who is eligible for surrogacy and where to start? where do you begin? ...
    Read More
    What to consider before you decide to opt for IVF treatment
    Getting an IVF done is not the first or natural choice for any couple desiring to have a baby. It is ...
    Read More
    Why is Sperm DNA Fragmentation Tests for male partner necessary in IUI and IVF?
    Sperm DNA fragmentation test is a crucial test in male infertility cases to check the extent of DNA ...
    Read More
    4 Steps to Coping with - PAIN - of IVF failures
    This article talks about the 4 simple steps of embracing grief of Failure, deal with it and how to m ...
    Read More
    Role of Endometrial Receptivity in Implantation Failure In IVF
    Find out what is endometrial receptivity and window of Implantation and how it impacts the implantat ...
    Read More
    Understanding Ovulation Induction. Why is it important in fertility Treatment?
    Every Couple facing Conceptions issues are given medicines/ injections to help them ovulate. Ovulati ...
    Read More
    Male Infertility Causes and Treatment | Antioxidant therapy to combat sperm damage
    What is oxidative stress and how does it cause male infertility. How does ROS alter sperms parameter ...
    Read More
    How DNA Fragmentation and Microfluidics are changing how we assess Sperm Quality
    Classical semen analysis is based mainly on sperm count, the number, ability of the sperm to swim an ...
    Read More
    Low – Cost Fertility treatment and EMI Financing options is building hope for couples from Low Income groups
    In private clinics the cost of an IVF cycle in the state varies anything between Rs. 1 lac and Rs. 2 ...
    Read More
    PRP therapy is giving hope to couples advised for Egg donation to conceive with their own eggs
    PRP or Platelet Rich Plasma is an extract from the blood which has a concentrate of Platelets and ot ...
    Read More
    Why Pre Implantation Genetic Screening of Embryos is recommended after IVF Failure?
    The majority of abnormal embryos are indistinguishable from normal embryos when studied using a micr ...
    Read More
    Personalised Embryo Transfer is the next big game changer in IVF?
    The window of implantation is the period when the endometrium is receptive or ready for the embryo. ...
    Read More
    Fresh Vs Frozen Embryo Transfer. Which option yields better results?
    Why should couples opt for Frozen embryo transfer (FET) rather than same cycle transfer? How is FET ...
    Read More
    How do Polycystic Ovaries Affect Pregnancy
    Pregnancy is a wonderful aspect of a woman’s life. Nurturing a life in your womb is one of the best ...
    Read More
    Brief Summary of the Indian Laws on ART and Surrogacy
    What do Shah Rukh Khan, Karan Johar, and Tusshar Kapoor have in common? Well, they are all A-listed ...
    Read More
    5 Things You Should Know About Fertility
    If you are reading this article then chances are high that you are trying or planning to have childr ...
    Read More
    5 Tips that will see you through a Successful Surrogacy
    Being pregnant is one of the most wonderful feeling for any woman. However, things are a bit differe ...
    Read More
    Secondary Infertility - 8 Facts to Know
    Secondary fertility is when a woman cannot get pregnant or isn’t capable of carrying a pregnancy to ...
    Read More
    5 Common Myths About IVF Treatment
    Despite the growing popularity of in-vitro fertilization (IVF) as an effective solution for infertil ...
    Read More
    Corrective Surgeries That Are Performed Before IVF
    You may face unexplained fertility issues or have experienced failed IVF cycle. In such cases, often ...
    Read More
    Trying to Conceive - When is Sperm Aspiration Recommended
    Infertility due to male factor is not an uncommon issue. There are several factors that determine th ...
    Read More
    Why IVF Fails
    IVF or in-vitro fertilization is a process in which both egg and sperm are collected from the indivi ...
    Read More
    Role of Hysteroscopy in IVF
    What is Hysteroscopy, why is it so important ? Should we doing Hysteroscopy ...
    Read More
    Sperm Banking
    Information about Sperm Banking, both for Donors and also for those who wil ...
    Read More
    Life Begins at 40 with the Success of IVF
    Most women around the age of 30, whom I have seen do show apprehension regarding that particular age ...
    Read More
    Tubal Patency Testing Under Best IVF Clinic in Kolkata
    Fallopian tubes arise from the womb (uterus) and curve around the ovaries on either side. The ends o ...
    Read More
    Letrozole is Safe under Supervision of Infertility Specialist
    I am writing this article because Letrozole is a very commonly used drug by Infertility Specialists ...
    Read More
    Male infertility Evaluation - Physical examination of Infertile male
    Male fertility examination<br />
    Read More
    5 Reasons why you should opt for Frozen Embryo Transfer during IVF
    There are a lot of practices in ART that help ensure you can give the best chance for an embryo to i ...
    Read More
    Ovarian Drilling
    Women with PCOS (Poly Cystic Ovarian Syndromes) have irregular menstrual periods and do not ovulate ...
    Read More

    Useful Videos

    © 2020 Care Fertility Solutions Pvt Ltd. All Rights Reserved.

    Design By: AV Solutions