Male Fertility

On your way through fertility care, it’s possible to forget that men are half the equation. 50% of infertility cases are male factors. This is unfortunate because male infertility testing is a simple, low-cost, non-surgical procedure. Most importantly, most causes can be successfully treated

Infertility is defined as the inability to conceive a child within one year of unprotected intercourse. What is not always considered is that in 50% of cases, men play an important role in the infertility of the couple. Another way to look at this is that 7% of men suffer from infertility. Disease, injury, age, chronic health problems, lifestyle choices, and other factors can contribute to male infertility.

Male infertility contributes to infertility in about 50% of cases.



  • There may be no other obvious signs or symptoms. In some cases, however, a latent problem such as genetic disorder, hormonal imbalance, dilated veins around the testicles, or condition that prevents sperm passage cause signs and symptoms.
  • Sexual function problems – for example, difficulty in ejaculation or small amounts of fluid ejaculated, reduced sexual desire or difficulty maintaining erectile function
  • Pain, swelling in testicle area
  • Recurrent respiratory infections
  • The inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of chromosomal or hormonal abnormality
  • Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)



Male fertility is a complex process. To get your partner pregnant, the following should occur:

  • You must produce healthy sperm. Firstly, this involves the growth and formation of the male reproductive system during puberty. At least one testicle must work properly, and your body must produce testosterone and other hormones to stimulate and sustain sperm production.
  • Sperm must be carried to semen. Once the sperm are produced in the testicles, they are transported by delicate tubes until they mix with the sperm and ejaculated out of the penis.
  • There must be enough sperm in the semen. If the sperm count in your semen (sperm count) is low, it reduces the chances that a sperm will fertilize your partner’s egg. Low sperm count is less than 15 million sperm per milliliter of semen or less than 39 million each ejaculation.
  • Sperm must be well functioning and able to move. If the movement or function of the sperm is abnormal, sperm may not be able to reach or penetrate your partner’s egg.


Medical causes

Problems with male fertility can occur by a number of health issues. Some of these include:

Varicocele: Varicocele is a swelling in the veins that drain the testicle. It is the most common cause of male infertility. Although the exact cause of Varicocele infertility is unknown, it may be associated with abnormal temperature regulation in the testis. Varicocele leads to reduced sperm quality.

Treating Varicocele by improving  sperm count and function, and may improve outcomes when using assisted reproductive techniques such as in vitro fertilization.

–infection: Some infections can interfere with sperm production or sperm health or can cause scarring that prevents sperm from passing. These include inflammation of the epididymis (inflammation of the epididymis) or testicles (orchitis) and some sexually transmitted diseases, including gonorrhea or HIV. Although some infection may result in permanent damage to the testicles, it is often possible to retrieve sperm.

–Ejaculation problems: retrogradeejaculation occurs when the semen enters the bladder during orgasm rather than emerging out of the tip of the penis. Various health conditions can lead to retrograde ejaculation, including diabetes, spinal injuries, medications, bladder and prostate surgery, or urethra.

Some men who suffer from spinal cord injuries or some diseases cannot ejaculate semen, although they still produce sperm. Often in these cases it is still possible to retrieve sperm for use in assisted reproduction techniques.

–Antibodies that attack sperm: Sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.

— Tumors:  Cancer and non-malignant tumors can affect the male genitals directly, through the glands that release reproductive hormones, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

–Undescended testicles:  In some males, during the development of the fetus, one or both testicles fail to descend from the abdomen to the sac that usually contains testicles (scrotum). Decreased fertility is more likely in men who had this condition.

–Hormonal imbalances: Infertility can result from disorders in the testicles themselves or malfunction affecting other hormonal systems including the hypothalamus, pituitary gland, thyroid gland and adrenal gland. Low testosterone (male hypotgonadism) and other hormonal problems have a number of potential underlying causes.

–Defects of tubules that carry sperm: Many different tubes carry sperm. They can be blocked for various reasons, including accidental injury from surgery, previous infection, trauma or abnormal development, such as cystic fibrosis or similar inherited conditions.

The blockage can occur at any level, including inside within testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra. 

–Chromosomal defects: Genetic disorders such as Kleinfelter syndrome – where the male is born with two X chromosomes and one Y chromosome (instead of one X and Y) – cause abnormal growth of the male reproductive organs. Other hereditary syndromes related to infertility include cystic fibrosis, Kallmann’s syndrome and kartagener’s syndrome.

–Problems with sexual intercourse: These problems can include problems maintaining an erection sufficient for sex, premature ejaculation, painful intercourse, anatomical abnormalities such as an urethral opening beneath the penis (hypospadias), psychological problems or a relationship problems that interferes with sex.

–Celiac disease: A digestive disorder caused by sensitivity to gluten, celiac disorders can cause infertility in males. Fertility may improve after adopting a gluten-free diet.

–Previous surgical procedures:  Some surgeries may prevent you from having sperm in your ejaculate, including vasectomy, repair of the inguinal hernia, scrotal or testicular surgery, prostate surgery, and large abdominal surgeries performed for testicular. In most cases, the surgery can either be performed to reverse this blockage or to recover the sperm directly from the epididymis and testicles.


Risk factors

  • Risk factors associated with male infertility include:
  • Tobacco smoking
  • Using alcohol
  • Use of some illegal drugs
  • Overweight
  • Presence of a previous or present infection
  • Exposure to toxins
  • Overheated testicles
  • Trauma in the testicles
  • Perform previous vasectomy or abdominal or pelvic surgery
  • A history of Undescended testicles
  • Being born with fertility disorder or a blood relative witha fertility disorder
  • The presence of certain medical conditions, including tumors and chronic diseases, such as sickle cell disease


At Empower pharmacy we provide unique special medications used to treating fertility:

  • HCG injections: HCG treatment means getting two to three injections a week. Each treatment cycle runs for up to six months. It may take a year or two before treatment with HCG reaches maximum effectiveness.
  • Clomiphene Citrate capsules: Clomiphene can be used to treat cases of male infertility. These cases are considered “off-label” use. Clomiphene may help male fertility in a few ways. It can help increase sperm count levels and correct hormonal imbalances. It can also help you avoid surgical treatment. In other cases, it may help boost your odds of success after surgery.
  • FSH injections: If the cause is due to low testosterone, treatment with FSH injections is usually successful. However, it may take a year or longer of hormone therapy to get enough sperm production and bring back fertility.
  • Tamoxifen citrate: Tamoxifen exerts a beneficial effect on sperm density and count, motility and morphology.