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Problems With Sperm

By Robert W. Rebar, MD, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan;Gynecology &and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan



  • Semen is analyzed, and sometimes genetic tests are done.





What Causes Infertility in Men?



Reduced sperm production

Increased temperature of the testes

Excessive heat

Disorders that cause a prolonged fever

Hormonal disorders

Adrenal gland disorders (this gland produces testosterone and other hormones)





Pituitary gland disorders

Genetic disorders

Klinefelter syndrome

Other disorders that cause an abnormality in the sex chromosomes

Disorders of the testes


Injury to the testes

Mumps that affects the testes (mumps orchitis)


Tumors in the testes


Varicose veins in the testes (varicocele)


Anabolic steroids

Alcohol, when consumed in large amounts

Androgens (male hormones such as testosterone)


Aspirin when taken for a long time

Caffeine when consumed in excessive amounts (possibly)

Chlorambucil (a chemotherapy drug)

Cimetidine (used to treat stomach ulcers)

Colchicine (used to treat gout)

Corticosteroids taken by mouth (such as prednisone)

Cotrimoxazole (an antibiotic)

Cyclophosphamide (a chemotherapy drug)

Drugs used to treat malaria

Estrogens taken to treat prostate cancer

Gonadotropin-releasing hormone (GnRH) agonists (used to treat prostate cancer)



Medroxyprogesterone (a synthetic female hormone)

Methotrexate (a drug that suppresses the immune system)

Monoamine oxidase inhibitors (MAOIs—a type of antidepressant)

Nitrofurantoin (an antibiotic)

Opioids (narcotics)

Spironolactone (a diuretic)

Sulfasalazine (an antibiotic)

Exposure to industrial or environmental toxins

Heavy metals, such as lead


Phthalates (chemicals used to make plastics more flexible)

Polychlorinated biphenyl compounds (PCBs)

Absence of sperm in semen

Disruption of the sperm’s passage out of the body



Missing seminal vesicles (which provide nourishment for sperm)

Blockage of both ejaculatory ducts



Nervous system dysfunction

Pelvic surgery, such as prostate removal




Did You Know...

  • Using anabolic steroids can decrease sperm production.


  • Serious disorders of the testes




Locating the Male Reproductive Organs


  • A doctor's evaluation

  • A semen analysis

  • Sometimes testing for hormonal or genetic abnormalities


Semen analysis



If the semen sample is abnormal, the analysis may be repeated because samples from the same man normally vary greatly. Two or three samples, obtained at least 1 week apart, provide more accurate results than a single sample. If the semen still seems to be abnormal, the doctor tries to identify the cause. If there are too few sperm, doctors do genetic testing and measure levels of certain hormones, such as testosterone and follicle-stimulating hormone (which stimulates production of sperm in men). Also, urine may be checked for sperm after ejaculation to determine whether retrograde ejaculation is occurring.


Sometimes a biopsy of the testes is done to obtain more detailed information about sperm production and the function of the testes.

Other tests



  • Treatment of the cause

  • Clomiphene (a fertility drug)

  • If clomiphene is ineffective, assisted reproductive techniques



If men have a low sperm count with motile sperm that appear normal, intrauterine insemination (placing semen directly in the uterus) may slightly increase their partner’s chances of pregnancy. A technique that selects only the most active sperm (washed sperm) is usually used. With washed semen, pregnancy usually occurs by the sixth attempt if it is going to occur.

In vitro fertilization, often with intracytoplasmic sperm injection (the injection of one sperm into one egg), and gamete intrafallopian tube transfer (GIFT) are much more complex and costly procedures. They are successful in treating many types of male infertility. Intracytoplasmic sperm injection is the most effective method.


The partner of a man who has fertility problems may be treated with human gonadotropins to stimulate several eggs to mature and be released while intrauterine insemination is being tried. This approach may make pregnancy more likely.

Resources In This Article

* This is the Consumer Version. *