infertility causes in males

The best way to solve a problem is to find out what’s causing it. Infertility causes in males and females are no exception. 

I can’t even begin to count the number of people I know whose “miracle babies” are living proof that no doctor should ever say, “You’ll never be able to have a baby.” These babies bless the lives of parents with health conditions or who undergo medical treatments that greatly reduce the odds of a successful pregnancy. 

And with the right interventions, miracle babies become less miracle and more physiologically logical. 

In this blog, we’ll cover common but commonly overlooked infertility causes in males and females. I’ll also discuss the underlying reasons for repeat miscarriages, as the causes of infertility and miscarriage often overlap.  

Health conditions as infertility causes in males and females

Numerous health conditions can affect fertility and increase the risk of miscarriage. 

Doctors frequently diagnose ovarian cysts and PCOS as causes of infertility and miscarriage in females, while infertility causes in males commonly include varicocele (enlargement of the veins that drain the scrotum) and retrograde ejaculation.

However, some health conditions aren’t as apparent or easy to diagnose.

Elusive PCOS

The traditional symptoms of PCOS include missed periods, weight gain around the belly, acne and oily skin, and hirsutism, or excessive and often darkly colored body hair. 

But some cases of PCOS are difficult to diagnose, especially if the symptom pattern and lab results are atypical. Dr. Laura Briden is an expert on PCOS and hormonal balance. She notes that there are different patterns of PCOS, not all of which fit the classic picture. 

In fact, many women with PCOS are neither overweight nor experience hirsutism. Strikingly, not all women with PCOS even have ovarian cysts. Nor do all women with ovarian cysts have PCOS!

In 2003, the Rotterdam Criteria were established. These PCOS diagnostic guidelines state that out of three symptoms—polycystic ovaries, hyperandrogenism (an excess of testosterone in females), and irregular ovulation—two must be present for the diagnosis of PCOS. These criteria provided physicians a more accessible framework for the diagnosis of PCOS in women without traditional symptoms (1).   

Blood sugar irregularities

Blood sugar dysregulation is frequently involved in infertility causes in males and females. Diagnostically, it appears as hypoglycemia, or, conversely, prediabetes and diabetes.  

The most up-to-date hypothesis for blood sugar dysregulation is based on the underlying factor of inflammation. Poor dietary choices, such as processed foods or even macronutrient imbalances, hidden infections, and toxicant exposures are leading causes of inflammation. This, in turn, leads to metabolic disturbances that contribute to hormone imbalance and, sometimes, infertility.

Hashimoto’s hypothyroidism

Most doctors recognize the impact of hypothyroidism on fertility and pregnancy.

And while great advances have been made toward more comprehensive testing, most doctors continue to use TSH as the sole thyroid test for women of childbearing age. TSH simply measures the level of thyroid-stimulating hormone released by your pituitary gland. It doesn’t tell the whole story (or even much of the story) of your thyroid gland.

Ultimately, it’s important to know: 

  • the levels of active and inactive hormones the thyroid gland actually produces (T3 and T4)
  • if those hormones are bound to their carrier proteins or not (free T3 and free T4)
  • and if there is even the right amount of carrier proteins (T3 uptake) 

And TSH definitely doesn’t diagnose one of the most common causes of infertility and repeat miscarriage—autoimmune (Hashimoto’s) hypothyroidism.

To diagnose Hashimoto’s hypothyroidism, your doctor needs to know if you are creating high levels of self-antibodies to your thyroid tissue.

Autoimmune hypothyroidism is a very different problem from non-autoimmune hypothyroidism. 

While hypothyroidism is usually a problem with the thyroid gland, Hashimoto’s is a problem with the immune system that negatively affects the thyroid gland. It requires extensive immune and gut support, not just thyroid medication. 

Furthermore, the nutritional support needed by women with Hashimoto’s is quite different from the recommendation for women with stand-alone hypothyroidism. Learn more here and here.

Last but not least, Hashimoto’s hypothyroidism is one of the infertility causes in males, too. 

It may lead to changes in sperm function and lowered sperm count, as well as decreased levels of testosterone and sex hormone-binding globulin. It can also be an underlying reason for lack of libido and impotence (2). 

Celiac disease and non-celiac gluten sensitivity

Undiagnosed celiac disease can act as a health condition and a nutritional deficiency condition. 

And while it’s more prevalent in females, it may simply be that women seek medical support differently than men. Some screening studies show that celiac disease occurs in men as often as women (3). 

Unfortunately, it can have a detrimental effect on fertility and healthy pregnancy progression in females and males. 

Add to this the fact that celiac disease has risen along with rates of infertility—it’s increased an average of 7.5% per year over the past few decades.

Untreated celiac disease’s autoimmune-related progression can result in a decreased fertility window, “unexplained” infertility, increased risk of pregnancy complications such as miscarriage and stillbirth, and shortened breastfeeding period (4). 

However, the good news is that once celiac disease is diagnosed and a gluten-free diet is adopted, these tendencies often resolve.  

Beyond celiac disease, non-celiac gluten sensitivity, or NCGS, is a very real condition that joins the list of infertility causes in males and females (5). Learn more about gluten here.

Bacterial, fungal, & viral infections

There are many ways that microbial infection from bacteria, fungi, and viruses can contribute to infertility, such as inflammation that negatively affects egg and sperm function, hormonal disturbances, oxidative stress, fever, and antibody buildup (6). 

Awareness of infection’s role in infertility is especially pertinent during the COVID-19 pandemic. 

Some research shows that infection with the novel SARS virus, though not mRNA vaccination (7), can lead to reductions in:

  • semen volume
  • sperm concentration
  • sperm count
  • sperm motility
  • progressive motility

The most substantial statistical effect of COVID-19 infection is reduced sperm motility, possibly the most important of all sperm parameters (8). These effects may last for up to 90 days after infection. However, with proper support, parameters will hopefully return to baseline once the infection is resolved.

Nutritional deficiencies as infertility causes in males and females

Even if you have a great diet, read this section! 

Nutritional deficiencies can manifest for reasons other than poor eating habits. For example, you may eat great foods but not absorb them because of a functional or medical health issue.

Conventional, processed, and fake foods

Only real foods have the nutrition we need for conception. Foods grown with pesticides, herbicides, and fertilizers may look like the real thing, but their nutritional value is often different. Scientific studies show that organic foods rate higher in nutrient content than conventionally grown food.

Unfortunately, soil depletion due to mono-cropped agriculture means our fruits and vegetables contain measurably lower vitamin and mineral levels today than those of a few decades ago. So even when we choose biodynamic or organic options, we may still need some nutritional supplementation to meet our preconception and pregnancy needs.

Underconsumption of protein and fat

Amino acids, fats, cholesterol, and fat-soluble vitamins make major contributions to healthy fertility and pregnancy. Male and female sex hormones use cholesterol as a precursor. Proteins provide long-lasting energy to fuel daily activity and reduce our reliance on processed sugars for energy. 

These macronutrients are also critical for sustaining a pregnancy and fetal development. In particular, the brain and nervous system rely on whole-food fats.

Healthy fats help us absorb fat-soluble vitamins A, D, E and K that support fertility and fetal development. The research on the importance of these nutrients is so strong that week 1 of my Feed Your Fertile Body!™ program focuses on fats and fat-soluble vitamins.

Celiac disease

As mentioned above, men and women who have unexplained infertility sometimes have celiac disease. 

And contrary to popular belief, many people with celiac disease never experience the hallmark digestive symptoms. 

Get tested if you have unexplained infertility or nutritional deficiencies—celiac disease often results in very low levels of certain nutrients such as iron, zinc, vitamin D, B12, and folate (9). 

Of course, if you have celiac disease, you can reduce its impact on fertility by strictly avoiding gluten in food and non-food sources and by consuming a nutrient-dense diet.

Keep in mind that nutritional deficiencies drive many health conditions, not just celiac disease. And in turn, health conditions often deplete specific nutrients. In the next section, we’ll take a look at toxic exposures, which also deplete nutrients.

Toxic exposures

Exposures to environmental toxicants are wildly underreported infertility causes in males and females. Miscarriages and proper fetal development may also be connected to toxic burdens.

Common exposures include glyphosate, pesticides, phthalates, toxins in your drinking water, and many home and body care products. 

Unfortunately, heavy metals are another issue to keep on your radar. Mercury depletes nutrients needed for fertility and fetal development. Moreover, studies show that lead is among the leading causes of infertility and miscarriage, as well as pre-eclampsia and pregnancy hypertension.

Keep an eye out for part 6 of this series, where I’ll take a deep dive into toxic exposures and fertility.