The causes of infertility in men
The causes of infertility in men are less known than those responsible for female infertility. Which doesn't mean they don't exist. We now know that approximately 30% of cases of infertility in a couple are linked to the woman, 30% to the man, 30% to both. The remaining 10% correspond to infertility problems with unknown origins.
Male infertility problems occur at different levels: sperm production, sperm-conducting channels, hormonal system or even lifestyle.
Various causes
A pregnancy can be made difficult because of the poor quality of the sperm. Abnormalities in the number or in the mobility of the sperm prevent them from reaching and effectively fertilizing the oocyte. The origin of this insufficient quality often remains unknown.
In some cases, the origin of infertility is genetic. There are a few situations where the complete absence of sperm in the semen (azoospermia) can result from a mutation in the DNA. A mutation in the gene responsible for cystic fibrosis can cause an absence of sperm-conducting ducts. It has also been established that a Y chromosome abnormality can lead to a decrease or absence of sperm production.
Wearing pants or underwear that are too tight in the pelvis is often cited as a cause of infertility in men. And that's true! Because of the local increase in the heat of the testicles. This increase must nevertheless be of long duration during the day to have a deleterious effect. In much rarer cases of subfertility, exposure to too much heat in the testicles can be due to the anatomy: for example if blood vessels pass too close to the testicles – in the case of a venous disease called varicocele (although its effect on fertility remains controversial) – or whether the sex glands remain inside the abdomen (cryptorchidism).
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Another rarer cause of male subfertility is a clogged duct that brings sperm from the testicles to the outside. Closure of the ducts may either be present from birth or may result from a vasectomy or other surgical procedure.
In rare cases, it is a genetic or systemic disease that disrupts male reproduction, such as a hormonal disease, or even diabetes or cancer treated with chemotherapy. It seems that obesity is also a factor in reducing the chances of conception.
Infection by a microbe – bacteria or virus – is also a known cause, as is chronic or acute inflammation of the testicles.
The style of life
Lifestyle effects, in both men and women, have an impact on fertility. Excessive alcohol consumption can have an adverse effect on sperm quality. Smoking, cannabis use and coffee are also singled out, even if their effects are disputed or not sufficiently proven.
Disruptions to sexuality also pose a risk to fertility. Certain erection or ejaculation disorders can make a natural pregnancy impossible.
Finally, a man's age can affect his fertility, but to a much lesser extent than in a woman.
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Adapted from I want to understand… Medically assisted procreation (PMA), by Aurélie Coulon and Dr Nicolas Vulliemoz, in coll. with Pr Alexandre Mauron, Editions Planète Santé, 2018.
