Infertility Treatment in Men, Causes of Infertility, and Types of Treatment Methods

Infertility is a two-sided problem, and the scientific fact is that about 40 to 50 percent of couple infertility cases are due to male factors. But contrary to old misconceptions, there have been remarkable advances in men’s medical science that prove many of these cases are not only manageable but completely curable. The treatment of male infertility is entirely dependent on its underlying cause. For structural issues like varicocele or duct blockages, microsurgery is highly effective; for hormonal disorders, targeted drug therapy is prescribed; and for severe problems with sperm count, motility, or morphology, advanced assisted reproductive techniques like ICSI (direct injection of sperm into the egg) or TESE (sperm extraction from testicular tissue) significantly increase the chances of fatherhood. Nutrition and lifestyle changes also play a vital complementary role. In the remainder of this article, we review the most common causes of male infertility and the world’s latest treatment methods transparently, scientifically, and without causing undue worry. For specialized consultation, you can contact Raadina Health consultants.

Why is it Dangerous for Infertile Men to Copy Others’ Prescriptions?

Male infertility is a very complex condition. In some cases, the quality or motility of the sperm is low, or its morphology (shape) is abnormal. In others, it is caused by genetic problems or infections. Additionally, male fertility may be hindered by blockages along the sperm transport pathway. Therefore, a treatment that works for one person may be ineffective or even dangerous for another.

According to information published on the Medicine Plus website, evaluating male infertility is not possible merely through a sperm analysis; the doctor must conduct various assessments such as hormonal tests, ultrasounds, medical history reviews, and physical examinations to determine the main cause of infertility and the appropriate treatment method.

Patient Experience: Mehdi, 34, says: "After a year of unsuccessful attempts to have a child, on a friend's recommendation, I took supplements and hormonal medications for a few months because my friend had regained his fertility after taking them." When the supplements didn't work for Mehdi, he visited a specialist. After necessary tests, it was revealed that self-medicating had actually worsened his sperm analysis results. His actual sperm quality had been perfectly fine initially, but his primary issue was a blockage in the sperm transport pathway. His wife is now four months pregnant after he stopped the self-prescribed medication and began dedicated, specialized treatment.

Classification of Male Infertility Causes

The first step in treating male infertility is identifying the cause. Doctors generally categorize the causes of male infertility into two main groups: issues related to sperm production and issues related to sperm transport.

Sperm Production Problems

In these men, the testicles are unable to produce healthy sperm or enough of it. Sperm motility might be low, its shape might be abnormal, or the sperm count might be lower than normal. In very severe cases, there may be no sperm in the semen at all, a condition called Azoospermia. Various factors can lead to sperm production issues in men. Varicocele is a common cause where increased testicular temperature reduces sperm quality. Other causes of sperm production problems include:

• Hormonal disorders
• Genetic diseases
• Testicular infections
• Mumps infection after puberty
• Prolonged exposure to chemicals and industrial toxins
• Use of tobacco and alcohol
• Chemotherapy or radiation therapy
• Use of certain medications

Sperm Transport Problems

In the other group of infertile men, the testicles produce normal sperm, but the sperm cannot exit the reproductive tract or do not enter the semen during ejaculation. The main reasons for this problem include congenital or acquired blockages of the sperm transport ducts, vasectomy, spinal cord injuries, retrograde ejaculation, and complications from certain surgeries. According to ESHRE guidelines, multiple factors may simultaneously cause male infertility, which must be carefully evaluated and treated.

Physical Symptoms of Male Infertility

Unfortunately, male infertility does not always present clear symptoms. In fact, many men do not experience any signs of infertility until they actively try to have a child. However, some signs and symptoms should be taken as serious warnings, prompting a visit to the doctor at the earliest opportunity.

One of the most important signs is a change in the size or appearance of the testicles. Abnormal testicular shrinkage may indicate decreased sperm production. On the other hand, the sensation of pain, heaviness, or the presence of enlarged veins around the testicle may suggest a varicocele.

In men, sexual problems such as a reduced sex drive, erectile dysfunction, problems with ejaculation, or lower semen volume can also be warning signs of infertility. In some men, hormonal changes can cause problems such as too much or too little growth of facial and body hair, loss of muscle mass, or enlarged breasts (gynecomastia). These symptoms are related to a testosterone imbalance or other hormonal disorders and can directly affect sperm quality and male fertility.

Stages of Male Infertility Treatment

The treatment for each individual should be tailored to the cause of infertility, the age of the couple, the duration of infertility, and the general health of both partners according to the recommendations of the EAU (European Association of Urology). This is why a doctor will never give the same treatment plan to every patient. The general process of treating male infertility usually follows the steps below. The approach starts with the least invasive and simplest methods and moves to more advanced treatments if needed.

Stage One: Lifestyle Changes and Non-Pharmacological Measures

For many men, lifestyle changes can affect sperm quality, either directly or indirectly. Lifestyle modification is the most cost-effective treatment and can have a massive impact on sperm count, quality, and motility. However, with this method, you need to be patient because the sperm production process takes about 70 to 90 days. If you change your lifestyle, you will see the results a couple of months later. The following lifestyle changes work remarkably well:

• Temperature Control: Testicles need to be cooler than body temperature in order to make sperm. Repeated exposure to saunas, hot tubs, or very hot baths can increase testicular temperature and temporarily affect sperm production.
• Clothing: Tight underwear raises the temperature of the testicles and decreases ventilation. Opt to wear loose, cotton briefs instead.
• Electronics: Resting a laptop directly on your lap will produce heat and naturally bring your thighs closer together, raising your testicular temperature. It is better to place your laptop on a desk when working so it is not in direct contact with your body.
• Toxins: Chemicals in cigarettes, hookahs, and drugs can damage the DNA in sperm and make sperm less motile. Male fertility can be vastly improved by breaking these habits.
• Weight Control: Excess weight or obesity can impact male hormones and decrease sperm quality. Regular physical activity and maintaining a healthy weight contribute to overall health and proper functioning of the reproductive system.
• Diet: A diet high in vegetables, whole grains, fish, nuts, and healthy fats provides the nutrients needed to make sperm. Healthy nutrition can significantly improve fertility and sperm quality.
• Stress and Sleep: Sleep deprivation and chronic stress can affect the secretion of hormones vital for sperm production. Getting enough sleep and managing stress can be an integral part of the infertility treatment process.

Stage Two: Pharmacological and Hormonal Treatments

If lifestyle modifications do not resolve the issue, the doctor may initiate drug therapy and hormonal treatment. The type of medication prescribed depends on the root cause of infertility, meaning there is no single medication for all men. For instance, if a person has hormonal disorders, the doctor will prescribe medications to stimulate the production of hormones that affect spermatogenesis. In some patients, specific supplements or antioxidants are prescribed to reduce oxidative stress and improve sperm quality.

A crucial point is that you must never self-prescribe hormonal medications, especially testosterone. According to information from Medline Plus, unprescribed testosterone use is not only unhelpful but can sometimes lead to temporary infertility and a severe decrease in natural sperm production.

Stage Three: Specialized Male Surgeries

If male infertility is not resolved with medication, it implies the problem is structural and requires surgery. For example, if there is a blockage in the sperm transport ducts or complications from a vasectomy, certain reconstructive surgeries are performed. Likewise, if the doctor determines that a varicocele is the cause of reduced sperm quality, they will operate on it.

In specific cases where sperm is produced but does not enter the semen, the doctor uses surgical methods to extract sperm directly from the testicle or epididymis. It is highly important that you undergo surgery at a specialized, professional center under the supervision of an expert doctor.

Final Stage: Assisted Reproductive Technologies

If none of the above methods yield the desired result, or if the severity of the infertility is high, the doctor may suggest assisted reproductive technologies. Common assisted reproductive methods include Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Injection (ICSI). The choice of these methods depends on sperm quality, the woman’s age, the specific cause of infertility, budget, and other conditions of the couple.

New Treatments for Male Infertility

One of the latest techniques used for the treatment of male infertility is the use of advanced testicular sperm extraction techniques such as Micro-TESE. This technique is useful for men who do not have sperm in their semen, but there is a strong possibility of sperm production happening inside their testicles.

Another modern technique is the evaluation of sperm DNA integrity. Sperm count and quality (motility/morphology) may appear normal, but the sperm DNA might be damaged, which decreases fertility. In this scenario, specific targeted treatments are used.

Assisted reproductive techniques such as ICSI (injecting the sperm directly into the egg) have made significant advances in recent years. Today, professionals working in advanced laboratories can select sperm of good quality based on DNA health, motility, and morphology, and fertilize it in the lab. For many couples, this greatly improves the odds of a successful treatment.

Management of Azoospermia (Infertility without Sperm)

Azoospermia (the absence of sperm in the semen) does not necessarily mean absolute infertility. In this case, the doctor has to decide first what type of Azoospermia it is. It is divided into two main classes:

• Obstructive Azoospermia: The testicle is making sperm, but the transport path is blocked. In these conditions, surgery can sometimes repair the pathway, or sperm can be extracted directly from the testicle.
• Non-Obstructive Azoospermia: The problem lies in the production of sperm. This issue is caused by various reasons, such as genetic disorders, damage from chemotherapy, or hormonal problems. In this case, Micro-TESE surgery can often solve the problem.

Treating Infertility in Older Men

Unlike women, men do not have a strict age limit for producing sperm. However, this does not mean sperm quality remains constant with age. As men age, especially after 40 to 45, sperm count, motility, and DNA quality may gradually decline.

In older men, modifying controllable factors—such as quitting smoking, losing weight, engaging in regular physical activity, eating a healthy diet, and treating hormonal issues—impacts sperm quality more than anything else. That said, plenty of men safely father healthy children later in life.

Treating Infertility in Obese Men

Obesity and excess weight affect many parts of the body. The main problem with obesity in men is the reduction of testosterone levels and its increased conversion into estrogen. These changes throw the hormonal balance needed for sperm production completely out of balance and sometimes lead to a loss of libido.

Weight loss is usually the first line of treatment for infertility in obese men. A balanced diet and regular physical activity are at the forefront of the treatment process for these individuals. University of Utah Health states that even a five to ten percent weight loss can notably improve fertility markers in some men. However, weight loss must be done systematically, and extreme crash diets should be strictly avoided.

Does Chemotherapy Cause Male Infertility?

Yes. Some chemotherapy drugs can damage the sperm-producing cells in the testicles, impairing fertility temporarily or permanently. This damage depends on various factors, such as the type of drug, dosage, duration of treatment, the patient's age, and his fertility status before chemotherapy.

Statistics show that some men regain their fertility months or years after chemotherapy. In these cases, doctors highly recommend sperm freezing (cryopreservation) before chemotherapy begins, so the fertility potential of the sperm is not compromised by the intense treatment.

How Does Cancer Treatment Affect Male Fertility?

Cancer treatments usually involve methods like chemotherapy and radiation therapy. Much like chemotherapy, radiation therapy can impact the function of the male reproductive system. If radiation therapy is directed at the pelvic or testicular area, the risk of damage to the reproductive organs and fertility increases. Furthermore, in certain cancers related to the testicles, bladder, or prostate, surgical interventions may affect the sperm transport pathway or ejaculatory function.

Raadina Consultants: Your Smart Companion on the Fertility Journey

Male and female infertility undoubtedly cause a lot of worry and raise many questions. Nothing familiarizes you with the nuances of the treatment process and answers your questions quite like a specialized, professional consultation. You can ask your questions regarding necessary tests, treatment methods, duration, costs, and anything else, allowing you to proceed with treatment decisions with much greater peace of mind. At Raadina, professional and specialized consultants are ready to provide completely free counseling and answer all your questions. This ensures you step onto the path of treatment with tranquility.

Contact Us

Contact us for a free initial consultation about Male infertility

WhatsApp Telegram Facebook Email

Conclusion

About 50 percent of couple infertility cases are related to male infertility issues. The causes of male infertility are diverse. Blocked sperm transport ducts, an unhealthy lifestyle, obesity, and poor sperm quality/quantity are among the main reasons for male infertility. The treatment process is not the same for all men, and specialized treatments must be administered based on the specific type of underlying problem.

Get a free consultation, precise treatment planning, dedicated support, and a personalized medical travel roadmap. Contact the experts at Iran health agency today.

Frequently Asked Questions

What is the latest treatment for male infertility?

Currently, Micro-TESE surgical procedures for testicular sperm extraction, advanced sperm selection techniques, sperm DNA integrity assessments, and assisted reproductive methods like IVF and ICSI are considered the latest male infertility treatments.

Is there an injection for male infertility?

Yes. If male infertility has a hormonal cause, a doctor may prescribe hormonal injections like hCG or hMG. These medications must absolutely be used under a doctor's supervision and are not suitable for all patients.

What is the most important cause of male infertility?

The causes of male infertility vary, but the main reasons include varicocele, sperm production disorders, hormonal problems, blockages in the sperm transport ducts, and genetic factors.

Is there a definitive cure for male infertility?

The answer to this question depends on the cause of infertility. If the infertility issue stems from reasons like hormonal disorders or varicocele, they can be directly resolved. In some other cases, treatment only increases the probability of pregnancy but is not absolute/definitive.

What is the best pill for male infertility?

No single pill or supplement can be universally prescribed to treat male infertility for everyone. Self-medicating with pills can have the exact opposite effect. The type of drug therapy must be selected by a specialist doctor based on the specific cause of infertility.

If a man's sperm is weak, what should be done?

The first step is visiting a urologist and undergoing a sperm analysis. Once the cause is identified, the doctor will prescribe various methods such as lifestyle modification, drug therapy, surgery, or assisted reproductive methods, depending on the type and cause of the problem.

Does stress really cause male infertility?

Stress alone does not directly lead to infertility, but chronic stress disrupts the body's hormonal balance, reduces libido, and lowers sperm quality. Therefore, it will indirectly have a negative impact on male fertility over time.