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The main sign of male infertility is the inability to conceive a child. Often, there are no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited hormonal imbalance or a condition that blocks the passage of sperm may cause signs and symptoms. Male infertility symptoms may include:

• The inability to conceive a child
• Problems with sexual function — for example, difficulty reaching orgasm (delayed ejaculation) or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area.
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality

When to see a doctor
See a doctor if you:

• Are unable to conceive a child after a year of regular, unprotected sexual intercourse
• Have erection or ejaculation problems, low sex drive, or other problems with sexual function
• Have pain, discomfort, a lump or swelling in the testicle area.
• Have a lower than normal sperm count (fewer than 20 million sperm per milliliter of semen)
• Have a history of testicle, prostate or sexual problems
• Have had groin, testicle, penis or scrotum surgery

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Male fertility is a complex process. To get your partner pregnant, you must be able to produce healthy sperm that can reach, penetrate and fertilize your partner's egg. For this to occur:

• You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
• Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
• There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner's egg. A low sperm count is fewer than 20 million sperm per milliliter of semen.
• Sperm must be shaped correctly and able to move. If the movement (motility) or shape (morphology) of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner's egg.

Medical causes
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:

• Varicocele. A varicocele is a swelling of the veins that drain the testicle. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
• Infection. Some infections can interfere with sperm production or sperm health, or can cause scarring that blocks the passage of sperm. These include some sexually transmitted diseases (STDs), including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles due to mumps (mumps orchitis); and other infections of the urinary tract or reproductive organs.
• Retrograde ejaculation. This occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, multiple sclerosis, spinal injuries, and surgery of the bladder, prostate or urethra. Retrograde ejaculation can also be caused by certain medications — particularly medications for enlarged prostate, such as terazosin (Hytrin), tamsulosin (Flomax) and olealfuzosin (Uroxatral).
• Lack of ejaculation. Some men with spinal cord injuries or certain diseases can't ejaculate semen, even though they still produce sperm.
• Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them. This is especially common in men who've had a vasectomy.
• Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). In some cases, surgery to treat tumors can affect male fertility.
• Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that usually contains the testicles (scrotum).
• Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting the glands in the brain that produce testosterone and other hormones that control the testicles (the hypothalamus or pituitary glands). Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
• Sperm duct defects. The tubes that carry sperm (sperm ducts) can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one or both of the tubes that carry sperm out of the testicles. Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.
• Chromosome defects. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs.
• Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, or psychological or relationship problems that interfere with sex.
• Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
• Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antibiotics, some ulcer medications and certain other medications can impair sperm production and decrease male fertility.

Environmental causes
Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

• Pesticides. Some men exposed to pesticides such as ethylene dibromide and organophosphates have lowered sperm counts. Pesticide exposure has also been linked to testicular cancer. Most studies have been done on men who work in agriculture or live in agricultural areas.
• Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
• Exposure to radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
• Overheating the testicles. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods or wearing tight clothing also may increase the temperature in your scrotum and reduce sperm production.
• Prolonged bicycling. Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. In some cases, bicycle seat pressure on the area behind the testicles (perineum) can cause numbness in the penis and erectile dysfunction.

Health, lifestyle and other causes
Some other causes of male infertility include:

• Illegal drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
• Alcohol abuse. Heavy drinking can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may cause fertility problems.
• Tobacco smoking. Men who smoke may have a lower sperm count than do those who don't smoke. Secondhand smoke also may affect male fertility.
• Emotional stress. Stress may interfere with certain hormones needed to produce sperm. Your sperm count may be affected if you experience severe or prolonged emotional stress. A problem with fertility itself can sometimes become long term and discouraging, producing stress.
• Vitamin deficiency. Deficiencies in nutrients such as vitamin C, selenium, zinc and folate may contribute to male infertility.
• Weight. Obesity can cause hormone changes that reduce male fertility. Men who are underweight also may have reduced fertility.
• Age. Men older than 35 begin to have a gradual decline in fertility.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

A number of risk factors are linked to male infertility. They include:

• Being age 35 or older
• Smoking tobacco
• Abusing alcohol
• Using certain illegal drugs
• Being overweight
• Being underweight
• Having certain past or present infections
• Being exposed to toxins
• Overheating the testicles
• Having a prior vasectomy or vasectomy reversal
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Having certain medical conditions, including tumors and chronic illnesses
• Undergoing medical treatments, such as certain medications, surgery or radiation for cancer
• Bicycling for prolonged periods, especially on a hard seat or poorly adjusted bicycle

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Infertility can be stressful for both you and your partner. Complications can include:

• Surgery or other treatments for an underlying cause of low sperm count or other reproductive problems
• Expensive and involved reproductive techniques such as in vitro fertilization
• Stress related to the inability to have a child

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You're likely to start by seeing your family doctor or a general practitioner. However, when you call to set up an appointment, you may be referred to a specialist.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do
These steps can help you make the most of your appointment:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as refraining from having an orgasm (ejaculating) for a certain period of time or stopping certain medications.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Find out whether you have a family history of fertility problems. Having a male blood relative, such as your brother or father, with fertility problems or other reproductive issues may give clues to the cause of fertility problems.
• Make a list of all medications, vitamins and supplements that you're taking.
• 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.
• Write down questions to ask your doctor.

Time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For male infertility, some basic questions to ask your doctor include:

• What do you suspect may be interfering with my ability to father a child?
• Other than the most likely cause, what are other possible reasons my partner and I haven't been able to conceive a child?
• What kinds of tests do I need?
• Will my partner also need tests?
• What's the best treatment for my condition?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. If you see a doctor because you and your partner are unable to conceive, some questions your doctor may ask include:

• At what age did you start puberty?
• Have you had any sexual problems in this relationship, including difficulty maintaining an erection, ejaculating too soon or not being able to ejaculate?
• Have you ever fathered a child?
• Have you had a vasectomy or a vasectomy reversal?
• Do you use illegal drugs, such as marijuana, cocaine or anabolic steroids?
• Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
• Are you currently taking any medications, including dietary supplements?
• Do you regularly take hot baths or steam baths?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

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 — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

• General physical examination and medical history. This includes examination of your genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor may also ask about your sexual habits and questions about your sexual development during puberty.
• Semen analysis. Semen is generally obtained by masturbating and ejaculating into a special container at the doctor's office. Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections. Often sperm counts fluctuate from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.

Depending on initial findings, your doctor may recommend additional, more specialized tests that can help identify the cause of your infertility. These can include:

• Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor look for evidence of a varicocele or obstruction of the part of the testicle that stores sperm (epididymis). A small wand is moved over the surface of your scrotum to produce images on a video screen.
• Transrectal ultrasound. This test is similar to a scrotal ultrasound. To do this type of ultrasound, a small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and check for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
• Hormone testing. Hormones produced by the pituitary and hypothalamus glands and the testicles play a key role in sexual development and sperm production. Your doctor may recommend a blood test to measure your testosterone and other male hormones that can affect sperm count.
• Post-ejaculation urinalysis. This test involves collecting a urine sample after orgasm. The urine is checked for the presence of sperm. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
• Genetic tests. These tests are used if your doctor suspects your reduced sperm count or other fertility problems could be caused by an inherited sex chromosome abnormality. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing may also be ordered to diagnose Klinefelter's syndrome or cystic fibrosis.
• Testicular biopsy. This test involves removing samples from the testicle with a needle. It may be used if your semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.
• Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm. You are especially likely to have anti-sperm antibodies if you've had a vasectomy reversal.
• Vasography. In some cases, contrast dye is injected into each of the tubes that carry sperm (vas deferens) to check for blockage.
• Specialized sperm function tests. A number of different tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there's any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Treatment of male infertility depends on the cause, how long you've been infertile, your age and personal preferences. 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 can compensate for male fertility problems. Your doctor may try to improve your fertility by either correcting an underlying problem (if one is found) 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, your doctor may be able to recommend treatments that work.

Treatments for male infertility include:

• Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens can be repaired.
• Treating infections. If a blood test reveals high numbers of white blood cells, you may have an infection of the reproductive tract. Antibiotic treatment may cure the infection, but doesn't always restore fertility.
• Treatments for sexual intercourse problems. Treating conditions such as erectile dysfunction or premature ejaculation can improve fertility. Approaches can include medication or counseling.
• Hormone treatments and medications. In cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones, your doctor may recommend treatment with hormone replacement or medications that change hormone levels.
• Assisted reproductive technology (ART). For blockage of the vas deferens, retrograde ejaculation or other problems with sperm delivery, sperm can be taken directly from the testicle or recovered from the bladder and injected into an egg. The most common ART treatment is in vitro fertilization (IVF). This procedure involves surgically removing an egg from a woman's ovary, combining it with sperm in the lab, and then placing the fertilized egg into the uterus.

When treatment doesn't work
Sometimes male fertility problems can't be treated, and it's impossible for a man to father a child. If this is the case, your doctor may suggest that you and your partner consider either using sperm from a donor or adopting a child.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

There are a few steps you can take at home to increase your chances of achieving pregnancy:

• Increase frequency of sex. Having sexual intercourse every other day may increase your chances of getting your partner pregnant. However, ejaculating more often than every 48 hours may reduce your sperm count.
• Have sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. Experts generally recommend having intercourse every two days near the time of ovulation. This will ensure that sperm, which can live several days, are present when conception is possible.
• Avoid the use of lubricants. Some products such as Astroglide or K-Y jelly, lotions, and saliva have been shown to reduce sperm movement. Ask your doctor about sperm-safe lubricants.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Evidence is still limited on whether — or how much — herbs or supplements might help increase male fertility. Some, such as zinc, may help only if you have a deficiency.

Supplements that show some promise for improving sperm count or sperm quality include:

• Vitamin C
• Zinc
• Selenium
• Vitamin E
• Vitamin B-12
• Asian ginseng

Other supplements — including L-arginine and L-carnitine — may help improve sperm quality, but more research is needed.

Talk to your doctor before taking any herbal remedies or supplements, as some can cause harm when taken in high doses (megadoses) and some can cause problems when taken with certain medications.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Coping with infertility can be difficult. It's an issue of the unknown — you can't predict how long it will last or what the outcome will be. Infertility isn't necessarily solved with hard work. The emotional burden on a couple is considerable, and plans for coping can help.

Planning for emotional turmoil

• Set 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 repeated attempts. Some couples become so focused on treatment that they continue with fertility procedures until they are emotionally and financially drained.
• Consider other options. Determine alternatives — adoption, donor sperm or egg, or even having no children — as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness if conception doesn't occur.
• Talk about your feelings. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail.

Managing emotional stress during treatment

• Practice stress-reduction techniques. Examples include yoga, meditation and massage therapy.
• Consider going to counseling. Counseling such as cognitive behavioral therapy, which uses methods that include relaxation training and stress management, has been associated with higher pregnancy rates.
• Express yourself. Reach out to others rather than holding in feelings such as guilt or anger.
• Stay in touch with loved ones. Talking to your partner, family and friends can be very beneficial. The best support often comes from loved ones and those closest to you.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Many types of male infertility aren't preventable. However, you can avoid some known causes of male infertility:

• Don't smoke.
• Avoid excessive drinking.
• Steer clear of illegal drugs.
• Keep the weight off.
• Don't get a vasectomy.
• Avoid the heat.
• Reduce stress.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.