Male/Sperm Factor Infertility and Secondary Infertility

By
Shannon M. Clark, MD
|
October 6, 2021
Male/Sperm Factor Infertility and Secondary Infertility

Learn from a fertility specialist!

Infertility affects many people trying to conceive. Almost half of all cases of infertility may be from male factor infertility or sperm infertility. Male/sperm factor infertility can be caused by a variety of conditions; some of these can be corrected, while others cannot. While I am not a reproductive specialist, I still get a lot of questions around this topic, which is why I buddied up with someone who is an expert in fertility to fully discuss the truths and science behind male factor/sperm infertility! In this conversation with REI Specialist, Dr. Allison Rodgers, we discuss male factor/sperm infertility, including the causes, risk factors, medical causes, role of lifestyle habits, diagnosis, semen analysis, and more.

Male/Sperm Factor and Secondary Infertility

Basics of a male/sperm factor infertility evaluation

Fertility in sperm producing individuals requires normal functioning of the hypothalamus, the pituitary gland, and the testes. The standard evaluation for infertile couples includes testing of both partners. About 10% of infertility can be attributed to male/sperm factors only, while 35% of cases involve both partners. Thus, almost half of all couples with infertility may have a male/sperm factor etiology.


Male factor/sperm infertility problems may exist in sperm production, delivery, or transport. 30-40% of cases are due to problems in the testes, 10-20% are due to a blockage in the pathway that allows sperm to exit the testes during ejaculation (sometimes caused by previous infection), 1-2% of cases are due to problems in the pituitary or hypothalamus, and 40-50% of cases have no identifiable cause, even after evaluation.

Medical conditions that put patients in a high-risk group for male/sperm factor infertility

These include the following:

  • Endocrine disorders or hormone imbalances
  • Brain tumors, thyroid gland disease, diabetes, multiple sclerosis, and genetic diseases
  • Physical injury to the testicle
  • Undescended testes
  • Surgery on the testis or in this area, such as hernia repairs
  • Exposures to toxic chemicals including chemotherapy or radiation
  • Physical blockage of the sperm delivery routes
  • Use of testosterone or other anabolic steroids

Another source of infertility is secondary infertility

This is the inability to conceive a child or carry a pregnancy to full term after previously giving birth. To be classified as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization. Secondary infertility is typically diagnosed after trying unsuccessfully to conceive for six months to a year. It is just as common as primary infertility with an estimated 11% of couples struggling with secondary infertility. It can be traced to either partner or both partners. About one-third of cases originate in the egg producing partner and about one-third originate in the sperm producing partner.

What are the causes of secondary infertility in sperm producing partners?

One cause is reduced testosterone level. Testosterone plays a key role in sperm production. Testosterone levels can decline due to aging, injury to urinary or genital organs, or certain medical conditions like thyroid diseases, diabetes, and even emotional stress.

Another common cause of low sperm production and infertility is testicular varicocele. This is an enlargement of veins in the scrotum, or the sack of skin encasing the testicles. About 30% of infertile sperm producing individuals have testicular varicocele.

What should a couple do if they suspect secondary infertility?

If you suspect secondary infertility, schedule an exam with your healthcare provider, reproductive endocrinologist or urologist. Don’t delay. Early evaluation is critical to ensure the widest variety of treatment options. Your doctor will review your medical history to determine if anything has changed since your previous pregnancy. The doctor will ask if you’ve experienced irregular menstrual cycles and will want to find out if you’re ovulating and producing eggs normally. For sperm producing individuals, a medical history will show if thyroid disease, cancer or age-related conditions might have affected sperm count or quality.

If you suspect infertility or are having trouble conceiving, discuss it with your healthcare provider. As I said at the beginning, infertility may still seem taboo but there are a myriad of healthcare providers, tests, and methods to help you through it.


Shannon M. Clark, MD

Shannon M. Clark, MD

Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.

Follow Shannon on TikTok @tiktokbabydoc, Facebook @babiesafter35, and Instagram @babiesafter35.

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