Merck Manual

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What Causes Infertility in Men?

What Causes Infertility in Men?

Cause

Examples

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)

Hyperprolactinemia (high levels of prolactin, a hormone that stimulates milk production)

Hypogonadism (low levels of testosterone and/or impaired production of sperm), sometimes related to obesity

Hypothalamic disorders (the hypothalamus is the part of the brain that controls the pituitary gland, which controls testosterone production)

Genetic disorders

Other disorders that cause an abnormality in the sex chromosomes

Disorders of the testes

Infections

Injury to the testes

Mumps that affects the testes (mumps orchitis)

Shrinking of the testes (as can occur when excess alcohol is regularly consumed)

Tumors in the testes

Undescended testes (testes that remain in the abdomen rather than move to the scrotum)

Varicose veins in the testes (varicocele)

Drugs

Anabolic steroids

Alcohol, when consumed in large amounts

Androgens (male hormones such as testosterone)

Antiandrogens (drugs that counteract the effects of androgens, such as bicalutamide, cyproterone, and flutamide)

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 (hormonal drugs used to treat prostate cancer, fibroids, endometriosis, and other disorders)

Ketoconazole

Marijuana

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

Pesticides (which can have effects similar to those of female hormones or decrease the effects of male hormones)

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 epididymides (which provide the space and environment for sperm to mature), usually in men with cystic fibrosis

Blocked or missing vasa deferentia (tubes from the epididymides to the ejaculatory ducts), usually in men with cystic fibrosis

Missing seminal vesicles (which provide nourishment for sperm)

Blockage of both ejaculatory ducts

Retrograde ejaculation (semen travels back into the bladder rather than out of the penis)

Diabetes mellitus

Nervous system dysfunction

Pelvic surgery, such as prostate removal

Removal of lymph nodes in the area behind the abdomen (as may be done to treat Hodgkin lymphoma)

Erectile dysfunction (the inability to attain or maintain an erection sufficient for sexual intercourse)

Blood vessel disorders

Diabetes mellitus

Brain and nerve (neurologic) disorders, such as Alzheimer or Parkinson disease, multiple sclerosis, stroke, and nerve damage due to prostate surgery

Psychologic problems, such as performance anxiety or depression

Certain drugs, such as some antidepressants, certain hormonal drugs, and drugs used to treat high blood pressure (including beta-blockers)

Recreational drugs (such as cocaine, heroin, and amphetamines)

Unknown causes (idiopathic)