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JAMA PATIENT PAGE | Reproductive System
Male Infertility
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.
Male Reproductive Anatomy
Seminal
vesicle
BLADDER
Prostate
Urethra
Sites of semen
production
Rectum
Penis
Anus
Vas deferens
Epididymis
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.
Authors: James A. Kashanian, MD; Robert E. Brannigan, MD
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.
1770
Testicle
Site of sperm
production
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.
FOR MORE INFORMATION
• American Society for Reproductive Medicine
www.reproductivefacts.org/topics/detail.aspx?id=1331
• Society for the Study of Male Reproduction
www.ssmr.org
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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JAMA May 5, 2015 Volume 313, Number 17 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
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