Men's Reproductive Health
Reproductive health is an important component of men's overall health and well-being. Too often, males have been overlooked in discussions of reproductive health, especially when reproductive issues such as contraception and infertility have been perceived as female-related. Every day, men, their partners, and health care providers can protect their reproductive health by ensuring effective contraception, avoiding sexually transmitted diseases (STDs), and preserving fertility.
Common issues in male reproductive health include:
- Avoiding sexually transmitted diseases
Men's Reproductive Health: Condition Information
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 health care 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 health care 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 health care 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 health care 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.
How effective is male contraception?
Not all contraceptive methods are appropriate for all situations, and individuals should consult their health care 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 (va-SEK-tuh-mee) is a surgical procedure that cuts, closes, or blocks the vas deferens (pronounced vas DEF-uh-renz). This procedure blocks the path between the testes and the urethra (yoo-REE-thruh).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
How can men reduce the risk of getting a sexually transmitted disease (STD)?
Men can take the following measures to avoid STDs:
- Know your partner's STD and health history
- Talk to your health care 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 (pronounced pap-uh-LOH-muh) 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 health care 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 health care 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 health care 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 health care 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.
How common is male infertility, and what are its causes?
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 (pronounced VAR-i-koh-seel), an enlarged vein in the testicle. Varicocele is present in about 40% of men with infertility problems.7
What treatment options are available for male infertility?
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 health care 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.
Men's Reproductive Health: NICHD Research Goals
The ability to control one's own reproductive health includes not only avoiding reproductive and sexually transmitted diseases, but also the ability to have children at a time and manner that best ensures the future health of the child, the family, and the community.
NICHD research on contraception and birth control addresses a range of goals, from using advances in genetics to identify novel contraceptive leads, to identifying new strategies for improving contraception use. Some specific NICHD research goals related to male contraception include (but are not limited to) the following:
- Designing new nonhormonal contraceptive approaches that capitalize on the biology of the testes and epididymis
- Increasing knowledge about the factors that control spermatogenesis to design specific compounds for male contraception
- Analyzing long-term health effects, including effects on the prostate and on bone mass, of new agents for male contraception
- Studying the sustained use of contraception and the reasons for discontinuation, inconsistent use, and method switching
The NICHD supports and conducts a wide range of research related to STDs. Research areas include:
- Factors and behaviors that affect the risk of contracting or spreading STDs
- Developing new interventions to prevent the spread of these conditions in vulnerable populations
- Improving the understanding of the best ways to communicate with people about STDs and effective preventive measures
- Clinical research to test prevention and treatment methods for STDs
Addressing issues related to infertility in both men and women is a central part of the NICHD mission. The Institute conducts and funds research on various aspects of infertility, including:
- Causes of infertility
- Therapies for treating infertility
- Conditions and disorders that are associated with infertility
- The economic impact of infertility and its treatments
Men's Reproductive Health: Research Activities and Scientific Advances
The NICHD relies on several organizational units to study different aspects of male reproductive health. The information below describes a few of these activities.
Much of the Institute's research on contraceptive agents and their evaluation is done through the Contraceptive Discovery and Development Branch (CDDB). The CDDB is the largest source of support for research on contraception within the federal government. It has responsibility for contraception research and development and for contraceptive and reproductive evaluation.
Using a combination of grants and contracts, the Branch supports and/or conducts the following activities:
- Phase I, II, III, or IV clinical trials to evaluate the safety and efficacy of new contraceptive methods for women and men
- Research to develop methods for male contraception, including hormonal and nonhormonal control of sperm production and/or sperm function
- Experimental studies in animals to determine the safety and efficacy of novel potential contraceptive agents
The Institute's Population Dynamics Branch funds studies of sexual behaviors and their relationship to disease prevention in a variety of populations. This includes basic and intervention research on the demographic, social, and behavioral aspects of the sexual transmission of HIV and other sexually transmitted diseases.
At the Fertility and Infertility (FI) Branch, the mission is to alleviate infertility, discover new leads on contraceptives, and expand basic scientific knowledge about human reproduction.
Researchers in the Institute's Division of Intramural Research investigate the molecular basis of peptide hormone control of gonadal function, with particular emphasis on the structure and regulation of the luteinizing hormone and prolactin (PRL) receptor (PRLR) genes, concentrating studies on the function and regulation of gonadotropin-regulated testicular RNA helicase (GRTH/DDX25), an essential post-transcriptional regulator of spermatogenesis that was discovered, cloned, and characterized in their laboratory. The various functions of GRTH/DDX25 provide fertile ground for the development of a male contraceptive.
Research efforts from these organizational units have led to the following scientific advances related to men's reproductive health.
Potential Nonhormonal Male Contraceptive
Despite decades of research into hormonal and immunological methods of male contraception, no regimen based on either of these approaches is near clinical approval. Compounds called bisdichloroacetyldiamines have been shown to safely and effectively suppress spermatogenesis in men. However, these compounds also cause an adverse reaction when co-administered with alcohol, and this has prevented their introduction for contraceptive purposes. Researchers supported by the NICHD and the National Institute of General Medical Sciences have now demonstrated that the contraceptive effect of these compounds is mediated by inhibition of testicular retinoic acid biosynthesis via a specific enzyme. This finding may allow for the development of novel, specific inhibitors of spermatogenesis that do not cause the adverse reaction and can be developed into a safe, effective, and reversible form of male contraception. For more information on this finding, visit http://www.ncbi.nlm.nih.gov/pubmed/20705791.
Home Fertility Test for Men
Every year, more than 7 million couples report having infertility problems. About one-third of infertility cases are the result of male issues, one-third are due to female issues, and the other third are due to combined issues of the couple or are unknown. Although home fertility tests are available to women, male fertility tests have typically been available only through health care providers.
SpermCheck Fertility® is a newly developed test that allows men to check their sperm count in the privacy of their homes. The test takes about ten minutes and involves adding semen samples to a plastic cartridge, which resembles and gives a similar reading as a pregnancy test. After adding the semen sample, the appearance of lines on an indicator strip tells the user if the sperm count is normal, low, or very low. Since sperm count is one of the first things tested in a fertility clinic, the new test now allows this to be quickly and inexpensively checked with a home test. This home test for men is an important addition to home fertility tests, which provide valuable, private information to couples experiencing fertility problems. For more information on this research, visit http://www.ncbi.nlm.nih.gov/pubmed/20139122.
The CDDB supports the following research efforts related to men’s reproductive health:
- The Contraceptive Clinical Trials Network (CCTN)conducts clinical trials of new contraceptive drugs and devices. The CCTN includes two sites specifically for evaluating male contraceptives. Network research includes studies of progestin- and testosterone-based topical gels designed to reduce gonadotropin levels and reversibly inhibit sperm production in order to provide effective, user-controlled hormonal contraception for men.
- The Preclinical Contraceptive Development Program (PCDP) conducts a wide range of research with the ultimate goal of developing useful contraceptive products for men. Research focuses for the PCDP include studies on:
- Mechanisms regulating how spermiogenesis might be targeted by novel male contraceptives
- Signaling pathways for the protein receptor c-Ros in male fertility
- Sperm glycolytic enzymes
- Nonhormonal targets for male contraception, including the tight junctions between Sertoli cells and germ cells, which are required for appropriate cell-cell interactions during sperm development (spermatogenesis)
- Injectable formulation of acyline, a potent gonadotropin-releasing hormone antagonist, to assess drug safety and ability to suppress spermatogenesis
- Novel male contraceptives, including H2-gamendazole, an orally active anti-spermatogenic compound
- Pharmaceutical targeting of a sperm-specific calcium cation channel (CatSper) and consequences of targeting on male fertility
- The Contraceptive Development Research Center Program aims to identify new contraceptive products. The centers are interactively organized to allow research on discovering and/or developing promising new leads for regulation of fertility, as well as additional relevant projects. Individual projects focus on basic, preclinical, or clinical research, or on a combination of these areas related to topics in both women’s and men’s reproductive health.
- The Male Reproductive Health Research Career Development Program was established in 2006 to advance the career development of clinicians who specialize in male reproductive health. The program aims to increase the clinical research capacity of practitioners in male reproductive biology and promote the translation of basic research to clinical practice