Infertility in Men

Infertility is not being able to conceive after a year of trying. This means having regular, unprotected sex. About one-third of cases are caused by male factors. An equal number are caused by female factors. In the remaining cases, the cause is unknown or is due to problems with both partners.

Fertility in men depends on the following organs:

• Hypothalamus
• Male reproductive organs (testes, vas deferens, epididymis)
• Pituitary gland

Men are considered infertile if they:

• Have chronic problems with ejaculation
• Produce sperm cells of poor quality
• Produce too few sperm cells

In about half of the cases, a cause cannot be found. Some factors that can contribute include:

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

These factors increase your chance of developing infertility:

• Birth defects of the male reproductive system, including history of undescended testicles
• Exposure to toxic chemicals or heavy metals, such as lead
• Nicotine use, long-term marijuana or cocaine use , steroid use, opiate use , and certain prescription drug use
• Past infections, including sexually transmitted diseases (STDs), mumps , prostatitis
• Brain tumors , pituitary tumors
• Chemotherapy
• Cystic fibrosis
• Diabetes
• Exposure to diethylstilbestrol (DES) in the womb
• Kartagener's syndrome
• Klinefelter syndrome
• Liver disease
• Malnutrition
• Multiple sclerosis
• Obesity , high body mass index
• Overheating of the testicles
• Radiation treatment
• Spinal cord injuries

Tell your doctor if you have any of the above risk factors.

After one year of trying to conceive, you and your partner should get help.

During the first visit, you will both be evaluated. The doctor will ask about symptoms, medical history, and work history. Chemicals at your job could have an effect. Your doctor will look for physical problems that might cause infertility.

The following tests will be done:

• Blood tests—to find out the levels of different hormones that play a role in sperm development, including:
  • Follicle stimulating hormone
  • Luteinizing hormone
  • Prolactin levels
  • Testosterone
• Other tests:
  • Biopsy —removal of a sample of testicle tissue for testing
  • Fertilization tests—to determine how well the sperm can penetrate an egg
  • Post-coital test—to check if your sperm is compatible with the mucus in your partner's cervix
  • Ultrasound —a test that uses sound waves to examine structures inside the body; 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
• Semen analysis —examined for:
  • "Clumping" of sperm
  • Amount of semen
  • Consistency of semen
  • Movement of sperm
  • Number of sperm
  • Presence of substances other than sperm in the semen
  • Shape of sperm

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

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

• Avoid:
  • Excessive use of alcohol
  • Exposure to harmful chemicals and heavy metals
  • Use of tobacco, marijuana, opiates, and anabolic steroids
• Protect yourself from STDs by using condoms . Minimize the number of sexual partners you have.