Doctor Answers: Can Prostatitis Cause Infertility?

The prostate gland weighs only about 20 grams, yet it plays a critical role in a man’s overall health. Some men wonder if prostate conditions—especially prostatitis—could impact their fertility. But can prostatitis cause infertility?

We spoke with Dr. Parra, a specialist in men’s reproductive health, to clarify whether this common inflammatory condition of the prostate can really affect a man’s ability to father children. 

During our conversation, Dr. Zayed provided detailed medical insights and relevant research on prostatitis infertility. Everything presented here has been carefully reviewed to ensure accuracy and reliability.

Q: What Is Prostatitis?

Dr. Parra answers: Prostatitis is one of the most frequently encountered conditions in urology, especially in younger men—unlike benign prostatic hyperplasia, which is more common with age. Prostatitis statistics indicate men have about a 14% chance of experiencing prostatitis at some point in their lives, and a significant portion of diagnoses occur in individuals under 50 years old.

Essentially, prostatitis refers to inflammation of the prostate, and it may be acute or chronic. Often, it stems from bacterial infection; however, some patients show no signs of infection at all. Acute bacterial prostatitis resembles a urinary tract infection (UTI) in symptoms:

• Dysuria: Burning or painful urination
• Nocturia: Frequent urination at night
• Urinary urgency and sometimes difficulty initiating flow
• Abdominal pain or lower back pain
• Painful ejaculation and possibly discomfort in the testicles or penis

There’s also a condition called Chronic Pelvic Pain Syndrome, which includes patients diagnosed with chronic prostatitis but lacking a clear bacterial cause. Their hallmark is intermittent pain that significantly impairs quality of life.

Q: What Is Male Infertility?

Dr. Parra answers: Infertility can affect both men and women. In men, it’s defined by an inability to make a woman pregnant after at least 12 months of regular, unprotected intercourse. According to the World Health Organization, about 15% of couples experience infertility, and half of these cases involve some degree of male factor infertility.

Typically, male infertility stems from problematic sperm production or inadequate sperm delivery. An example is obstructive azoospermia, where a blockage prevents sperm from appearing in the ejaculate. There are numerous medical conditions that can undermine male fertility—among them, varicocele is quite common. However, genital tract infections are another key factor deserving attention.

Q: What’s the Link Between Prostatitis and Infertility?

Dr. Parra answers: Research suggests that UTIs and prostatitis may be responsible for a considerable number of infertility cases in men. Data shows around 12% of male infertility might be attributable to infections, including prostatitis, orchitis, and epididymitis.

For men affected by prostatitis, sperm quality can be compromised in various ways. Some studies point to changes in sperm morphology, motility, and function, though not all research has found these effects consistently. Much depends on what’s causing the prostatitis and other underlying health factors.

One proposed mechanism is that the immune system launches an autoimmune response against prostate tissue, inadvertently damaging sperm. This interplay between inflammation, infection, and sperm health is central to understanding how prostatitis may contribute to male fertility problems.

Q: Why Can Prostatitis Lead to Infertility?

Dr. Parra answers: Multiple mechanisms can explain a possible link between prostatitis and infertility. Here are some of the key factors:

A Dysfunction in the Secretory Function of the Prostate

The prostate secretes essential fluid components—like zinc, fructose, and citric acid—that help maintain sperm motility and overall function. During inflammation, the gland may produce less of this vital prostatic fluid. Though by itself this reduction might not always cause full infertility, it can be part of a multifactorial problem.

Antisperm Antibodies

In some men, an autoimmune response targets prostate tissue and may also create antibodies against sperm cells. Known as antisperm antibodies, these immune factors are more frequently identified in nonbacterial, especially autoimmune-linked, prostatitis. They can decrease sperm count and motility, exacerbating inflammation and tissue damage in the process.

Free Radical Damage

Inflammation sets the stage for oxidative stress. Free radicals—or reactive oxygen species—are produced by white blood cells reacting to infection or irritation. These molecules can break down sperm structures, reduce motility, and even damage their DNA.

Infertility Caused by Microorganisms

In bacterial prostatitis, infectious agents like Escherichia coli have been shown to negatively impact sperm motility and damage the sperm cell’s tail or midpiece. Chlamydia trachomatis can cause sperm death, lowering the sperm count. Additional microbes—enterococci, mycoplasma, and Ureaplasma urealyticum—may also reduce a man’s fertility potential.

Erectile Dysfunction and Ejaculatory Problems

Chronic pelvic pain and inflammation can make it challenging for men to achieve or sustain erections. Pain upon ejaculation, premature ejaculation, or general sexual dysfunction might further hinder natural conception.

Q: Can Infertility Caused by Prostatitis Be Treated?

Dr. Parra answers: Yes. Prostatitis treatment can be difficult—particularly in chronic forms—but many options exist:

• Antibiotics: If bacteria are involved, antibiotic therapy is often the first step. Notably, some studies show improved pregnancy rates in couples where the male partner underwent a three-week course of antibiotics.
• Antioxidants: Because oxidative stress can harm sperm quality, antioxidants administered over at least six months may help.
• Anti-Inflammatory Drugs and Herbal Therapies: As research indicates, these may alleviate inflammation and relieve symptoms in some cases.

Often, infertility involves multiple contributing issues, not just prostatitis. Addressing the inflammation may help, but it’s also wise to explore other potential fertility barriers (e.g., varicocele, hormone imbalances) with a healthcare provider. Even for men requiring assisted reproductive techniques, treating prostatitis first is advisable to enhance sperm quality. According to the study, elevated leukocytes in semen can undermine fertility treatments.

Key Patient Questions on Prostatitis Infertility

Q: Can I get pregnant if my husband has prostatitis?

Dr. Parra answers: Yes. A woman can get pregnant even when her husband has prostatitis. Remember that conception only requires a single functioning sperm cell, and even if the sperm count and quality are reduced along with the chances of conception, they rarely reach near an absolute zero.

However, systematic reviews and meta-analyses have proven that prostatitis affects a man’s fertility rate. Studies show that this effect is more common in chronic prostatitis and less frequent in acute episodes of the disease. It more frequently affects patients with chronic bacterial prostatitis, causing the formation of anti-semen antibodies and reducing sperm vitality, total sperm count, and progressive motility.

On the other hand, patients with non-bacterial prostatitis or chronic pelvic pain syndrome can also reduce their pregnancy rate. These patients more commonly have a reduced sperm volume and sperm cell concentration, with a reduction in progressive motility and normal sperm morphology.

Despite a reduction in conception rate, there’s always a possibility of getting pregnant, even if your husband has prostatitis. Other comorbidities can also interfere with sperm count and reduce the chance further, which is why a reproduction specialist is recommended if you are worried about pregnancy and your husband’s sperm quality.

Q: Does the duration of prostatitis (acute vs. chronic) change its impact on fertility?

Dr. Parra answers: Yes. Most studies on semen quality and fertility problems are focused on chronic prostatitis. Acute prostatitis is less likely to have an impact on fertility unless associated with comorbidities with a direct effect on sperm count.

Acute prostatitis has a short duration and is less likely to interfere with fertility. Most patients improve their symptoms and reverse the effect of prostate inflammation in a matter of days or weeks before any effect can be seen on their fertility rate. The disease is less likely to have a lasting impact on prostate function and sperm quality, unlike chronic bacterial prostatitis, which changes how the prostate gland works in the long term.

When the prostate remains inflamed for months, it starts working differently. Its permeability is affected, and the transport of nutrients and substances becomes impaired. For instance, a study shows that zinc levels in the sperm are lower in patients with chronic bacterial prostatitis compared to the baseline. These changes in prostatic fluid nutrients can be responsible for the reduction in sperm vitality in patients with chronic prostatitis.

Acute prostatitis may not affect the fertility rate as much as chronic prostatitis, but the symptoms are usually more severe during the first stage of the disease and may reduce the patient’s interest in intercourse due to pain symptoms. Pain during intercourse and ejaculation can also indirectly affect fertility or cause transient sexual dysfunction problems. However, these are quickly resolved after antibiotic treatment.

Q: What kind of follow-up testing should be done to confirm if prostatitis treatment has improved fertility parameters?

Dr. Parra answers: If you’re worried about fertility, a semen analysis is an appropriate test for fertility parameters. This laboratory test evaluates sperm count, morphology, motility, and other aspects of sperm cells influencing their fertility rate. It can be used before, during, or after prostatitis treatment to ensure that there’s a high chance of conception after intercourse during fertile days.

Additional follow-up tests that may be useful include a free testosterone blood check, which may be required in senior male patients, and a prostatic ultrasound scan, which may help detect prostatic changes that influence prostatic fluid.

Studies show that fertility parameters tend to improve shortly after completing the antibiotic course. However, to reduce the impact of prostatitis on sperm quality, frequent ejaculation is recommended along with antibiotics during treatment and 3 months after completing your treatment to improve fertility parameters. This study recommended ejaculating every third day or more frequently to clear our prostatic tissue from leucocyte infiltration more rapidly after completing antibiotic treatment.

Q: Could hormonal imbalances be a hidden factor linking prostatitis and infertility?

Dr. Parra answers: Hormonal imbalances can be a comorbidity problem that influences infertility, along with prostatitis. It is also widely known that hormonal factors play a significant role in prostate ailments, including prostatitis.

A study in patients with low testosterone levels shows that low testosterone is associated with a higher chance of experiencing prostatitis-like symptoms. Patients with chronic prostatitis/chronic pelvic pain syndrome sometimes have hormonal imbalances as a hidden factor that could be influencing a prostatic problem and causing infertility simultaneously.

Another study shows that testosterone levels and the patient’s testosterone-to-estrogen ratio can influence prostate health and inflammation rate. In other words, the more testosterone you have, the more likely your prostate will be protected from chronic inflammation. A higher level of estrogen is associated with apoptosis and a higher level of inflammatory markers in the prostate.

Put simply, hormonal imbalances can be the reason why some patients have a harder time recovering from prostatitis. It can be a hidden factor behind frequent recurrences and relapse symptoms in patients with chronic prostatitis and chronic pelvic pain syndrome. It may also influence the fertility rate and sexual health, linking prostatitis with fertility problems.

Q: Are there specialized diagnostic tools to directly evaluate prostatitis-related sperm damage beyond a standard semen analysis?

Dr. Parra answers: The typical semen analysis report includes a macroscopic revision of semen, which includes semen volume, liquification, and color. Semen volume is essential to maintain a high sperm count but may become affected in patients with prostatic ailments. Liquification of semen happens typically in the range of 15 to 30 minutes and can affect sperm motility when it is delayed. Sperm color can be a sign of sperm damage, as in the case of bleeding and jaundice.

The typical semen analysis report also has a microscopic and chemical analysis section, which includes an assessment of sperm shape, sperm motility, sperm count, and pH levels. Abnormal sperm shape is usually linked with genetic problems and causes infertility. Reduced sperm motility is more likely influenced by prostatitis and prostate health problems and affects the sperm cell’s ability to reach the egg. The sperm count can also be affected by prostate problems, and it should be over 15 million cells per millimeter. The pH level is vital to avoid sperm cell damage on their way to reach the egg.

Additional semen parameters that may come in handy after prostatitis treatment include a micronutrient analysis and a leucocytospermia check. The prostate provides nutrients to the sperm volume, which is fundamental to maintaining sperm vitality inside the womb. Studies show that patients with prostatitis may reduce micronutrient levels, especially zinc levels. Leucocytospermia is the evaluation of the presence of leucocytes in the sperm, which may linger for a few months after treatment, according to studies.

Q: What if a couple still cannot conceive after resolving prostatitis—could there be lingering effects on fertility?

Dr. Parra answers: Prostatitis can have lingering effects on fertility in some cases, but this mainly affects patients with chronic prostatitis/chronic pelvic pain syndrome. Patients with bacterial prostatitis usually resolve their infection, and any effects on fertility rate or sperm quality are reversed after treatment. To accelerate treatment, some authors recommend frequent ejaculation combined with antibiotics to clear the prostatic tissue from inflammatory markers faster.

However, the most common association between prostatitis and fertility problems is through non-bacterial prostatitis. These patients usually have long-term effects on the fertility rate, and since the ailment is not always fully resolved, the problem stays for a more extended period and may affect the couple and their ability to conceive.

A recent review published in the Life journal addressed the issue of fertility in patients with chronic prostatitis and mentioned how different mechanisms came into play to affect sperm quality. The tip of the iceberg is prostatic inflammation, which impairs the secretory capacity of the gland and can be addressed by anti-inflammatory drugs or herbal remedies. However, a high proportion of patients with prostatitis and infertility also have a case of metabolic syndrome, which contributes to the problem. In their case, a combination of healthy dietary choices and physical activity may help reverse insulin resistance and improve the fertility rate. These patients should also be screened for circulatory and vascular problems, such as varicocele, which affects testicular health and sperm quality. 

Conclusion

So, can prostatitis cause infertility? While there are many reasons men may struggle to conceive, prostatitis stands out as one significant factor, particularly in younger adults. It’s the third-most common diagnosis in men who visit a urologist. Inflammatory processes, immune responses, and changes to prostatic secretions can all work together to decrease fertility potential.

The good news is that in many cases, effectively treating prostatitis helps reverse or improve fertility issues. However, if other problems exist, it’s important to address them. By recognizing the multifactorial nature of male infertility, healthcare professionals can create a comprehensive plan—potentially returning your chances of fathering a child to a healthier state.

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