Definition

A couple is considered infertile if they cannot conceive after a full year of regular, unprotected sex. About one-third of all cases are caused by male factors. An equal number are caused by factors in the female. In the remaining cases, the cause is unknown or is due to problems with both partners.

Causes

The Male Reproductive System

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Fertility in men depends on the functioning or a variety of organs. These include the pituitary gland, male reproductive organs (testes, vas deferens, epididymis), and the hypothalamus. Men are considered infertile if they produce too few sperm cells, sperm cells of poor quality, or have chronic problems with ejaculation.

In about half of the cases, a cause cannot be determined. It is not always possible to identify the cause of problems with sperm quality, quantity, or ejaculation. Some factors that can contribute include:

  • Genetics diseases like Klinefelter syndrome and Sertoli-Leydig cell syndrome
  • Exposure to some workplace chemicals or heavy metals (primarily lead and cadmium)
  • Tobacco use
  • Marijuana use
  • Varicose veins of the testes (varicocele)
  • Abnormal hormone levels
  • Infections
  • Physical abnormalities
  • Cancer
  • Medications
  • Obesity
  • Chronic diseases like sickle cell anemia
  • Excessive physical activity
  • Anti-sperm antibodies

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for male infertility include the following:

Symptoms

A couple should seek help for infertility if they are unable to conceive after one year of trying. They will both be evaluated to determine if the infertility is due to the male, the female, or a combination of both.

Diagnosis

During the initial consultation, both partners will be evaluated for fertility problems. The doctor will ask about any symptoms and your medical history, and perform a physical exam. During the physical exam, your doctor will look for varicoceles and any physical abnormalities that might cause infertility. Basic urine and blood tests will be performed. An occupational history can help your doctor determine if chemicals at the worksite could play a role.

Blood tests are done to find out the levels of different hormones that play a role in sperm development. The hormones include testosterone, luteinizing hormone, follicle stimulating hormone, and prolactin levels.

The key test that will be performed is a semen analysis. The sample will be examined for the:

  • Amount of semen
  • Consistency of semen
  • Number of sperm
  • Movement of sperm
  • Shape of sperm
  • "Clumping" of sperm
  • Presence of substances other than sperm in the semen

Ideally a sample should be collected at the doctor’s office. The sample is typically sent to the lab within an hour of collection.

Other tests may include:

  • Ultrasound —a test that uses sound waves to examine structures inside the body. A transrectal ultrasound may be done to look for any enlarged vein around the testicles.
  • X-rays —a test that uses radiation to take a picture of structures inside the body
  • Fertilization tests—to determine how well the sperm can penetrate an egg
  • Biopsy —removal of a sample of testicle tissue for testing
  • Post-coital test—to check if your sperm is compatible with the mucus in your partner's cervix

Treatment

Treatment will depend on the cause of the infertility. Infertility treatments can be costly and lengthy. They often are not covered by insurance, so be sure to check with your insurance company.

Lifestyle Changes

Your healthcare provider may suggest that you first try to make some changes such as:

Medication

Hormonal imbalances can be treated with medications.

Surgery

Surgery is sometimes performed to correct structural abnormalities. This can be done for conditions like varicocele. A treated varicocele does not, however, restore fertility. Surgery can be done to reverse a vasectomy , although this procedure is not always successful or possible.

Assisted Reproductive Technologies (ART)

ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from the couple or can be donated. ART methods include:

  • Artificial insemination—Semen is collected and processed in a lab and then inserted directly into the woman's cervix or uterus.
  • In vitro fertilization (IVF) —An egg is removed from the woman's body and mixed with sperm in a laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's uterus.
  • Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—An egg is removed from the woman's body and mixed with sperm in a laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's fallopian tube.
  • Blastocyst intrafallopian transfer—An egg is removed from the woman's body, injected with sperm, and allowed to develop to an embryonic stage called the blastocyst. This multi-celled blastocyst is implanted into the woman's uterus.
  • Intracytoplasmic sperm injection—A single sperm is actually injected into the egg, rather than just combined with the egg. The resulting embryo can be implanted into the woman's uterus, or frozen for later use.

Prevention

Infertility cannot always be prevented. But the following steps may help:

  • Avoid use of tobacco, marijuana, opiates, and anabolic steroids.
  • Avoid exposure to harmful chemicals and heavy metals.
  • Avoid excessive use of alcohol.
  • Protect yourself from sexually transmitted disease by using condoms and minimizing the number of sexual partners.