Infertility is a complex disorder with significant medical, psychosocial, and economic consequences. The prevalence of infertility varies depending on the criteria (clinical – 1 year, epidemiological – 2 years, demographic – 5 years) and whether the outcome is pregnancy or births. Nonetheless, its prevalence is particularly high in sub-Sahara ranging from 20% to 60% of couples. (Ogunniyi et al., 1999).   

In countries such as Nigeria, female factors and unexplained infertility accounts for 50-80% while the male factor accounts for 20-50% of the cause of infertility (Esimai et al., 2002).  Given that about 50% of the time, men are the primary or contributing reason, male infertility is worth discussing.

What is infertility in males?

Infertility in males is a major public health problem defined as inability of a man to impregnate a woman after 12 months of regular and unprotected sexual intercourse. However, this is particularly problematic as it relies on an outcome of his female partner who may have reproductive issues of her own.

What are the causes of infertility in males?

Sperm production takes place in the scrotum where the temperature is 3-4 degrees lower than the core body temperature, because of this, sperm health can be decreased by anything that raises the scrotum’s temperature.

Sperm quality can be impacted by extreme heat exposure to the testicles, which can occur by wearing tight clothing, using hot tubs frequently, and placing laptops or heating pads on or near the testes.

Other causes of male infertility include, infection, injuries, toxin exposure, anatomic variations, chromosomal abnormalities, systemic disorders, and sperm antibodies (Nsota et al., 2019).              

With all these potential causes, here are some common ones that are worth knowing;


This occurs when veins become enlarged inside the scrotum (the pouch of skin that holds the testicles). This condition results in larger-than-normal veins on the testicles, which heats them up and changes the number or form of sperm produced.

Cancer treatment

Fertility in men can be affected both temporarily and permanently as a result of cancer therapies such as surgery, radiation, and chemotherapy. The duration of sperm recovery following radiation and gonadotoxic effects are dependent upon various factors such as the quality of the initial sperm, gonadal dosage, mode of administration following chemotherapy, frequency and dosages, and the stage of sperm formation that each drug affects.


This is a surgical procedure done by cutting and sealing off part of each tube called the vas deferens which supplies sperm to the semen. Although it might be possible to reverse this procedure, there’s no guarantee it will work.


There are genetic reasons for low numbers or poor quality sperm which involves mutation in a region on the Y chromosome known as the azoospermia factor region (AZF). This mutation can only be detected during a fertility assessment so men can be infertile and have absolutely no idea.

  • Cystic fibrosis

Cystic fibrosis is a genetic disorder (heterogenous recessive) caused by mutations in a gene known as cystic fibrosis transmembrane regulator (CFTR). The majority of males with cystic fibrosis are characterized by an absence of the tube which is meant to supply sperm to the semen (vas deferens).

  • Klinefelter syndrome

Klinefelter syndrome is the most common sex chromosome disorder whereby affected males carry an additional X chromosome, which results in male hypogonadism (low testosterone), androgen deficiency, and impaired spermatogenesis. This results in poor quality of sperm produced and erectile dysfunction.

What role does medications and lifestyle play in infertility in males?

There are many lifestyle changes that have the potential to positively or negatively affect the quality of sperm.

  • Use of anabolic steroids in competitive or casual athletes disrupts the normal hormonal feedback between the testis and the brain resulting in reduced sperm counts.
  • High heat exposure to the testicles from tight clothing, holding laptops or heating pads on or near the testes can affect the quality of sperm.
  • Excessive alcohol intake reduces testosterone production.
  • Smoking and recreational drugs i.e. marijuana. Use of marijuana blocks sperm production by introduction of heavy metals. Tetrahydrocannabinol (THC) the active ingredient in marijuana blocks sperm mobility. Cadmium contained in cigarettes reduces sperm quality.
  • Medications such as drugs for prostate disease can alter sperm function.
  • Exposure to environmental toxins, such as chemicals, lead and pesticides which reduces sperm count and motility.
  • Sexual promiscuity greatly increases the risk of sexually transmitted diseases, such as gonorrhoea, chlamydia trachomatis, herpes, syphilis, and HIV which may cause infertility if left untreated.
  • Overall health and weight (obesity or underweight) can negatively influence sperm health. For example, some chemicals which can disrupt sperm production, survive for longer in the body if there is an abundance of fat.

What fertility treatments are available?

In many West African countries, male infertility can be treated by means including medications, surgical procedures as well as assisted reproductive interventions such as;

  • Varicocelectomy is a safe, simple, and effective treatment for varicocele.
  • Intracytoplasmic Sperm Injection (ICSI): It involves injecting a single sperm into an egg obtained from in vitro fertilization (IVF).
  • Hormone therapy, for example Clomiphene to reduce effect of low testosterone or Anastrozole to correct erectile dysfunction.

Across West Africa, there are many clinics that offer treatments for male infertility from specialists known as Andrologists. Here are a few:


Esimai, O.A., Orji, E.O., Lasisi, A.R. Niger J Med., 2002, 11:70-72.

Nsota Mbango, J. F., Coutton, C., Arnoult, C., Ray, P. F., & Touré, A. (2019, March 4). Genetic causes of male infertility: snapshot on morphological abnormalities of the sperm flagellum. Basic and Clinical Andrology, 29(1).

SO Ogunniyi, OO Makinde, and FO Dare. African Journal of Medicine and Medical Science, 1999, 19(4): 271 – 274.

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