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.
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:
Past infections, including sexually transmitted diseases,
mumps,
prostatitis
Birth defects of the male reproductive system, including history of
undescended testicles
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:
Change the timing of sexual activity.
Avoid excessive heat (steam rooms, saunas).
Avoid tobacco, marijuana, and excessive alcohol use.
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
vasectomy.
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.
RESOURCES:
American Society for Reproductive Medicine http://www.asrm.org
International Council on Infertility Information Dissemination http://www.inciid.org
RESOLVE: The National Infertility Association http://www.resolve.org
The Hormone Foundation http://www.hormone.org
CANADIAN RESOURCES:
Sex Information and Education Council of Canada http://www.sieccan.org/
Sexualityandu.ca http://www.sexualityandu.ca/eng/
References:
American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/.
American Society for Reproductive Medicine website. Available at:
http://www.asrm.org.
The National Institute for Occupational Safety and Health website. Available at:
http://www.cdc.gov/niosh/homepage.html.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
