Male infertility has many causes–from hormonal imbalances, to physical problems, to psychological and/or behavioural problems. Moreover, fertility reflects a man’s “overall” health. Men who live a healthy lifestyle are more likely to produce healthy sperm.

A man will be considered at risk of being infertile if his sperm count is less than 20 million/ml of semen. This level is defined by the World Health Organisation but it is important to realise that some men with low sperm counts (oligospermia) will still prove fertile whilst others with higher counts prove infertile. So a measure of sperm count is not a completely reliable method of assessing fertility. Azoospermia (no sperm cells are produced) is also another possible factor of male infertility.

Possible causes of a low sperm count:

• Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, benzene, boron, and heavy metals
• Smoking
• Excessive alcohol consumption on regular basis
• Prolonged use of marijuana and other recreational drugs
• The workaholic syndrome
• Excessive stress
• Malnutrition and anemia
• Inadequate vitamin C and Zinc in the diet
• Very frequent intercourse
• Overly intense exercise
• Heat can reduce sperm production (e.g. wearing constantly very tight underwear)

Modifying these behaviours’ can improve a man’s fertility and should be considered when a couple is trying to achieve pregnancy.

Other physical factors may contribute to reduced fertility, either by interfering with the sperm production process or disrupting the pathway down which sperm travel from the testes to the tip of the penis. These problems are usually characterized by a low sperm count and/or abnormal sperm morphology and which can be identified on examination include:

• Infected semen (from a disease), from mumps, tuberculosis, brucellosis, gonorrhoea, typhoid, influenza, smallpox, and syphilis can cause testicular atrophy. A low sperm count and low sperm motility are indicators of this condition.
• Varicocele, a varicocele is an enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart) and are present in 15% of the general male population and 40% of infertile men.
• Hydrocele, presence of excessive fluid around the testicle)
• Damaged Sperm Ducts, seven percent of infertile men cannot transport sperm from their testicles to out of their penis
• Torsion is a common problem affecting fertility that is caused by a supportive tissue abnormality which allows the testes to twist inside the scrotum which is characterized by extreme swelling.
• Retrograde ejaculation (a rare condition when some men ejaculate backwards into the bladder)

A rectal examination can help determine whether the prostate gland may be a source of chronic infection.

Additionally a small percentage of male infertility is caused by hormonal problems. The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm. Most common hormonal conditions are:

• Hyperprolactinemia, elevated prolactin, a hormone associated with nursing mothers, is found in 10 to 40 percent of infertile males.
• Hypothyroidism, low thyroid hormone levels–can cause poor semen quality, poor testicular function and may disturb libido.
• Congenital Adrenal Hyperplasia, occurs when the pituitary is suppressed by increased levels of adrenal androgens.
• Hypogonadotropic Hypopituitarism, low pituitary gland output of LH and FSH.? This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and Leydig (testosterone producing) cells to deteriorate.
• Panhypopituitafism, complete pituitary gland failure–lowers growth hormone, thyroid-stimulating hormone, and LH and FSH levels.

Several sexual problems exist that can affect male fertility. These problems are most often both psychological and physical in nature. It is sometimes difficult though, to separate the physiological and physical components.

Erectile Dysfunction (ED), also known as impotence, this condition is common and affects 20 million American men. ED is the result of a single, or more commonly a combination of multiple factors. In the past, ED was thought to be the result of psychological problems, but new research indicates that 90 percent of cases are organic in nature. However, most men who suffer from ED have a secondary psychological problem that can worsen the situation like performance anxiety, guilt, and low self-esteem.

Premature Ejaculation is defined as an inability to control the ejaculatory response for at least thirty seconds following penetration. Premature ejaculation becomes a fertility problem when ejaculation occurs before a man is able to fully insert his penis into his partner’s vagina.

Ejaculatory Incompetence, this rare psychological condition prevents men from ejaculating during sexual intercourse even though they can ejaculate normally through masturbation. This condition sometimes responds well to behavioural therapy.