Erectile dysfunction affects around 30 million people in the US, and is the most common sex-related problem that people with penises report to their doctor. For those who are trying to conceive a child, erectile dysfunction may cause fertility issues by making the process more difficult. Here is what you should know about how erectile dysfunction affects fertility, what causes it in the first place, and how to conceive when you or a partner has erectile dysfunction.

Takeaways:

• Erectile dysfunction is extremely common and may affect people of all ages.
• There are a number of physical and psychological contributors to erectile dysfunction.
• Erectile dysfunction can have indirect effects on fertility and may indicate underlying hormonal imbalance.
• Treatment options for erectile dysfunction include medication, intraurethral therapy, penis pumps, and implants.

What is erectile dysfunction?

Erectile dysfunction, commonly referred to as ED, is a condition in which a person is unable to get or keep an erection firm enough to perform satisfactory sexual intercourse. It can be a short-term problem that occurs only occasionally, or a long-term problem in which a person is never able to get an erection.

What causes erectile dysfunction?

Because male sexual arousal is a complex process that involves numerous parts of the body — from the brain and hormones to the nerves and blood vessels — there can be a number of causes and contributors for erectile dysfunction.

Age and erectile dysfunction

The chances of developing erectile dysfunction increase with age. This is likely because the conditions that cause ED — such as low testosterone and restricted blood flow — are more common with age. However, erectile dysfunction is not considered a normal part of aging.

And age is far from the only determining factor. A 2012 study from The National Center for Biotechnology Information (NCBI) found that 30% of men under the age of 40 experienced erectile dysfunction.

Physical causes for erectile dysfunction

• Restricted blood flow. Doctors estimate that 70% of the time erectile dysfunction can be traced to a physical condition that restricts blood flow, hampers nerve functioning, or both. These physical conditions may include clogged arteries, high blood pressure, or pelvic trauma.
• Prescription medications. According to a Harvard Special Health Report, 25% of all erectile dysfunction cases are the side effects of drugs like antidepressants, anti-ulcer drugs, tranquilizers, and diuretics. Medications for prostate surgery may also cause erectile dysfunction.
• Obesity. Obesity is also considered a significant risk factor for erectile dysfunction, with research indicating that 79% of men presenting erectile disorders have a BMI of 25 kg/m2 or greater.
• Tobacco use. A study in the American Journal of Epidemiology found that ED was more likely in men who smoked compared with those who never did. Smoking was largely to blame for erectile dysfunction in younger men.
• Low testosterone. Hypogonadism, a condition in which the testes fail to produce sufficient amounts of testosterone, may contribute to erectile dysfunction. In some cases, testosterone replacement has improved sexual response.
• Sleep disorders. A 2019 study found erectile dysfunction can be a consequence of several sleep disorders, including obstructive sleep apnea, insomnia, and circadian rhythm sleep disorders.
• Pelvic surgery. Prostate, bladder, and rectal surgeries can injure nerves or blood vessels, which may lead to erectile dysfunction.
• Neurological disorders. Erectile dysfunction is common in people with Parkinson’s disease, diabetes, multiple sclerosis, or spinal cord injury because of damage to neural pathways.

Psychological causes for erectile dysfunction

• Depression and anxiety. Studies show that men with erectile dysfunction often have comorbid symptoms of depression and anxiety. According to the Cleveland Clinic, in a person with depression, sex-related chemicals are out of balance. This results in low or missing sexual desire.
• Stress. Researchers have discovered that chronically elevated cortisol levels experienced during stressful events can produce impotence and loss of libido by inhibiting testosterone production in men.
• Relationship issues. Though erectile dysfunction often results in relationship problems, in some cases, the relationship problems happen first. Poor communication, a loss of emotional intimacy, and performance anxiety can all lead to a loss of libido and erectile dysfunction.

Can erectile dysfunction cause infertility?

Studies suggest that erectile dysfunction and/or premature ejaculation have a prevalence of one in six infertile men. Though erectile dysfunction does not necessarily affect sperm parameters or directly cause infertility, it can affect chances of conceiving a child by inhibiting one’s ability to maintain an erection in order to perform sexual intercourse and successfully fertilize an egg.

In some instances, studies show that erectile dysfunction and infertility may have the same root causes such as neurological defects like diabetes, multiple sclerosis, and Parkinson’s disease.

Is erectile dysfunction a sign of underlying infertility?

For some people, erectile dysfunction may indicate a hormonal imbalance. Imbalances in testosterone, follicle-stimulating hormone, and luteinizing hormone can all affect sexual function and fertility.  

Testosterone

According to the Urology Care Foundation, approximately 4 out of 10 men over age 45 have low testosterone or low “T” (also known as hypogonadism). Low testosterone levels may result in erectile dysfunction. However, low T won’t necessarily cause infertility. Many men with low testosterone can still produce healthy sperm.

Follicle-stimulating hormone

Follicle-stimulating hormone (FSH) is responsible for the creation of sperm in the testes. Researchers in a 2020 study found that men with low FSH levels were more likely to experience erectile dysfunction, decreased libido, and infertility. FSH deficiency can be caused by problems with the pituitary gland.

Luteinizing hormone

Luteinizing hormone is responsible for stimulating the production of testosterone; an imbalance in luteinizing hormone (LH) levels may also impact fertility and sexual function. This 2006 study shows a connection between increased LH levels and erectile dysfunction. And this 2011 study indicates that high LH levels may lead to testicular failure, resulting in infertility. 

What are the treatments for erectile dysfunction?

In the same way that erectile dysfunction may be a sign of infertility, researchers have noticed that the issue may also indicate other physical and mental health issues. By investigating multiple facets of sexual, general, and psychological health, doctors have the best chance of treating sexual dysfunction by treating its root cause.

If underlying health conditions are ruled out, possible treatments for erectile dysfunction include:

• Male enhancement pills. This may include PDE5 inhibitors like Viagra, Cialis, and Levitra, or herbal supplements like ashwagandha, fenugreek, or maca root powder. Typically male enhancement pills work by increasing blood flow to the penis.
• Alprostadil self-injection. This option involves using a fine needle to inject alprostadil, a medication that increases blood flow, into the base or side of the penis to prompt an erection that lasts no more than an hour.
• Intraurethral therapy. A small alprostadil suppository is placed within the penile urethra with this method, causing an erection.
• Penis pumps. A penis pump creates a vacuum effect that pulls blood into the penis to create an erection.
• Surgical penile implants. Inflatable or bendable rods can be placed surgically at the sides of the penis.

Urologists or primary care physicians are typically the providers who treat erectile dysfunction. Mental health professionals can also be helpful when erectile dysfunction is the result of — or results in — psychological issues.

Do these treatments affect fertility?

Though PDE5 inhibitors like Viagra, Cialis, and Levitra are often prescribed to treat erectile dysfunction, research indicates that they can negatively impact the acrosome reaction, the process by which sperm bonds with the egg during fertilization. These drugs can also be harmful for those with vascular disease.

Additionally, many herbal male enhancement pills have been shown to contain ingredients that can affect fertility, such as testosterone-boosters.

The other treatments listed above have not been shown to negatively impact fertility.

What if I have erectile dysfunction and want to have a baby?

If erectile dysfunction is hindering your ability to conceive a child, there are options for making the process easier. Intrauterine insemination, or IUI, is a method that involves placing sperm directly into your partner’s uterus around the time their ovary releases one or more eggs to be fertilized. This procedure allows you to freeze sperm in advance to use at the time of the insemination, in the case that it’s difficult to produce a sample on the day of the procedure.

Another option is surgical sperm retrieval, which may include testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Both options involve surgically retrieving sperm from the testicles. Sperm can then be cryopreserved or used immediately with intracytoplasmic sperm injection (ICSI), an IVF method in which a single sperm is injected directly into an egg.

Electroejaculation is an option to induce ejaculation in people with erectile dysfunction (especially as a result of spiral cord injury or nerve damage). EEJ is a process in which a probe is inserted rectally and pressed against the prostate, where it delivers an increasing frequency to stimulate ejaculation.

Finally, adopting a healthier lifestyle can have a positive effect on both erectile dysfunction and fertility. This includes eating well, limiting sugar and alcohol intake, exercising regularly, and addressing underlying mental health issues. Explore our comprehensive guide to sperm improvement for more healthy lifestyle tips.