Men's Reproductive Health

How can men protect their reproductive health and the health of their partners?

It is important for men to protect their reproductive health and that of their partners by:

• Using contraception carefully, consistently, and correctly
• Minimizing the risk of sexually transmitted diseases
• Addressing factors that may reduce fertility and seeking treatment when required

Men should consult with their healthcare provider to discuss which contraceptive method is best for the couple, based on overall health, age, frequency of sexual activity, number of partners, desire to have children in the future, and family history of certain diseases. Contraceptive methods work best when they are used correctly and consistently. Using contraception incorrectly or inconsistently increases the risk of pregnancy and in some cases also increases the risk of STDs.

It is important to discuss the risk factors for STDs with a healthcare provider and ask about getting tested. It is possible to have an STD and not know it, because many STDs do not cause symptoms. Men with STDs need to ask a healthcare provider about treatment to address symptoms, reduce the progression of the STDs, and decrease or eliminate the risk of transmitting an STD to your partner.

If you and your partner are interested in having children, but have difficulty conceiving, it is important for both the male and the female partner to consult with a healthcare provider to assess fertility. Over one-third of infertility cases are caused by male reproductive issues, alone or in combination with female reproductive issues. However, treatments are available to address many of the causes of male infertility.

Not all contraceptive methods are appropriate for all situations, and individuals should consult their healthcare providers to determine which method of birth control is best for them. For men, methods of contraception include male condoms and sterilization (vasectomy).

• Male condoms. This condom is a thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Male condoms are generally made of latex or polyurethane, but a natural alternative is lambskin (made from the intestinal membrane of lambs). Latex or polyurethane condoms reduce the risk of spreading sexually transmitted diseases (STDs). Lambskin condoms do not prevent STDs. Male condoms are disposable after a single use.^1,2
• Vasectomy is a surgical procedure that cuts, closes, or blocks the vas deferens. This procedure blocks the path between the testes and the urethra.³ The sperm cannot leave the testes and cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective. A backup method of contraception is used until tests confirm that there is no sperm in the semen. Although vasectomy can sometimes be reversed, it is not always possible. Vasectomy, like other sterilization procedures, is considered a permanent form of birth control.

Different methods of contraception have different rates of effectiveness in preventing pregnancy.

Contraception is most effective when used correctly and consistently. The failure rate increases if a method of contraception is used incorrectly.

According to the U.S. Department of Health and Human Services, male condoms have a failure rate of 11% to 16% (that is, from 11 to 16 women would be expected to get pregnant within one year if 100 women and their partners relied solely on male condoms for birth control). Male sterilization procedures have a failure rate of less than 1% if a backup method is used for the first several months after the procedure. For details about the effectiveness of specific methods of contraception, as well as potential side effects and risks, visit the website of the U.S. Department of Health and Human Services (HHS) Office on Women's Health.⁴

Men can take the following measures to avoid STDs:

• Know your partner's STD and health history
• Talk to your healthcare provider about your risk, and get tested for STDs
• Practice safe sex (such using latex condoms correctly and consistently)
• Get vaccinated against hepatitis A virus, hepatitis B virus, and human papilloma virus

According to the U.S. Department of Health and Human Services, the male latex condom is the best method for protecting against STDs, including HIV/AIDS.¹ Polyurethane condoms are an effective alternative if either partner has a latex allergy. Natural/lambskin condoms do not prevent the spread of STDs because of the presence of tiny pores (holes) that may allow viruses such as HIV, hepatitis B, and herpes to spread.

It is important to know that male condoms cannot completely protect you and your partner from contracting an STD. For example, the most common STD is the human papilloma virus, or HPV. No method of contraception can fully prevent the transmission of HPV, because it can infect areas not covered by a condom. However, using a condom with every sex act can lower the risk of transmission.²

It is important to discuss the risk factors for STDs with your healthcare provider and ask about getting tested. It is possible to have an STD and not know it, because many STDs do not cause symptoms.

See your healthcare provider for treatment as soon as possible after receiving a diagnosis of an STD. Notify all recent sex partners and advise them to see their healthcare providers and be treated. All sexual partners should be treated at the same time, to prevent re-infection. All partners should avoid sex until treatment is complete and your healthcare provider advises that it is safe to resume.

Many STDs have significant health consequences. Infections from STDs can cause infertility in both men and women. Some STDs can increase the risk of some forms of cancer. STDs can be passed on to the fetus during pregnancy or delivery. A person with an STD other than HIV is two to five times more likely to contract the HIV virus than a person without an STD. If a person is already HIV positive, having another STD increases the chances that they will pass the HIV virus on to their sexual partner.

Infertility is defined clinically in women and men who cannot achieve pregnancy after 1 year of having intercourse without using birth control, and in women who have two or more failed pregnancies. Studies suggest that after 1 year of having unprotected sex, 15% of couples are unable to conceive, and after 2 years, 10% of couples still have not had a successful pregnancy.^1,2 In couples younger than age 30 who are generally healthy, 20% to 37% are able to conceive in the first 3 months.³

Many different medical conditions and other factors can contribute to fertility problems, and an individual case may have a single cause, several causes, or—in some cases—no identifiable cause. Overall, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors.⁴

To conceive a child, a man's sperm must combine with a woman's egg. The testicles make and store sperm, which are ejaculated by the penis to deliver sperm to the female reproductive tract during sexual intercourse. The most common issues that lead to infertility in men are problems that affect how the testicles work. Other problems are hormone imbalances or blockages in the male reproductive organs. In about 50% of cases, the cause of male infertility cannot be determined.⁵

A complete lack of sperm occurs in about 10% to 15% of men who are infertile.⁶ A hormone imbalance or blockage of sperm movement can cause a lack of sperm. In some cases of infertility, a man produces less sperm than normal. The most common cause of this condition is varicocele, an enlarged vein in the testicle. Varicocele is present in about 40% of men with infertility problems.⁷

Other than the inability to conceive within a stated period of time or the inability to deliver a live-born infant, in most cases, infertility has no other outward symptoms.

The evaluation of a man's fertility includes looking for signs of hormone deficiency, such as increased body fat, decreased muscle mass, and decreased facial and body hair. The evaluation also includes questions about the man's health history, including past injury to the testicles or penis, recent high fevers, and childhood diseases such as mumps.¹ A physical examination allows for the identification of problems such as infection, hernia, or varicocele. A healthcare provider may also ask a man to provide a semen sample to assess the health and quality of his sperm. Other tests may include measurement of hormones in the blood, a biopsy of the testicle, or genetic screening.²

Treatments for male infertility may be based on the underlying cause of the problem, or in the case of no identified problem, evidence-based treatments that improve fertility may be recommended. Treatments include surgery to correct or repair anatomic abnormalities or damage to reproductive organs, use of medical procedures to deliver sperm to the woman, fertilization of the egg in a laboratory, and using a third party for donating sperm or eggs and/or carrying a pregnancy. Medication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction. Surgery can be effective for repairing blockages in the tubes that transport sperm. Surgery can also be used for repair of varicocele.² Assistive reproductive technologies, such as in vitro fertilization, can be effective if other treatments do not restore fertility.