Infertility in Men

Definition

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.

Causes

The Male Reproductive System

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Fertility in men depends on the following organs:

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

Men are considered infertile if they:

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

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

  • Genetics diseases (eg, Klinefelter syndrome, 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 (eg, sickle cell anemia)
  • Excessive physical activity
  • Anti-sperm antibodies

Risk Factors

These factors increase your chance of developing infertility:

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

Symptoms

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

Diagnosis

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:
    • Testosterone
    • Luteinizing hormone
    • Follicle stimulating hormone
    • Prolactin levels
  • Semen analysis—examined for:
    • 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
  • Other tests:
    • 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
    • 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 depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Lifestyle Changes

Your doctor may suggest that you first try:

Medication

If you have a hormonal imbalance, your doctor may prescribe medication.

Surgery

Surgery is done for conditions like varicocele. Though, a treated varicocele does not restore fertility. Surgery can be done to reverse a vasectomy. But, this is not always successful.

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 you and your partner or donated. ART methods include:

  • Artificial insemination—Semen is collected and processed in a lab. It is 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 lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
  • Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—An egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.
  • Blastocyst intrafallopian transfer—An egg is removed from the woman's body, injected with sperm, and allowed to develop. It is later implanted into the uterus.
  • Intracytoplasmic sperm injection—A single sperm is injected into the egg. The resulting embryo can be implanted into the 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
    • Exposure to harmful chemicals and heavy metals
    • Excessive use of alcohol
  • Protect yourself from STDs by using condoms. Minimize the number of sexual partners you have.

RESOURCES:

American Society for Reproductive Medicine
http://www.asrm.org

The Hormone Foundation
http://www.hormone.org/

RESOLVE: The National Infertility Association
http://www.resolve.org/

CANADIAN RESOURCES:

Men's Health Centre
http://www.menshealthcentre.net/

SexualityandU.ca
http://www.sexualityandu.ca/home_e.aspx/

References:

Infertility. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient_education/bp137.cfm. Published 2007. Accessed July 8, 2008.

Infertility. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 2008. Accessed July 7, 2008

Jorgensen N, Carlsen E, Nermoen I, et al. East-West gradient in semen quality in the Nordic-Baltic area: a study of men from the general population in Denmark, Norway, Estonia and Finland. Hum Reprod. 2002;17:2199.

Male risks. Protect your fertility website. Available at: http://www.protectyourfertility.org/malerisks.html. Accessed July 8, 2008.

Reproductive health. The National Institute for Occupational Safety and Health website. Available at: http://www.cdc.gov/niosh/homepage.html. Accessed July 8, 2008.

Swan SH, Brazil C, Drobnis EZ, et al. Geographic differences in semen quality of fertile US males. Environ Health Perspect. 2003;111:414.

Vasectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated May 2008. Accessed July 8, 2008.



Last reviewed February 2008 by Jill D. Landis, MD

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.

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