Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant.
About 13 out of 100 couples can't get pregnant with unprotected sex. There are many causes for infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery.
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Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility. These are the main causes of male infertility:
- Sperm Disorders
- Retrograde Ejaculation
- Immunonologic Infertility
Causes of male fertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis starts with a full history and physical exam. Your health care provider may also want to do blood work and semen tests.
History and Physical Exam
Your health care provider will take your health and surgical histories. Your provider will want to know about anything that might lower your fertility. These might include defects in your reproductive system, low hormone levels, sickness or accidents.
Your provider will ask about childhood illnesses, current health problems, or medications that might harm sperm production. Such things as mumps, diabetes and steroids may affect fertility. Your provider will also ask about your use of alcohol, tobacco, marijuana and other recreational drugs. He or she will ask if you've been exposed to radiation, heavy metals or pesticides. Heavy metals are an exposure issue (e.g. mercury, lead arsenic). All of these can affect fertility.
Your health care provider will learn how your body works during sex. He or she will want to know about you and your partner's efforts to get pregnant. For example, your healthcare provider may ask if you've had trouble with erections.
The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor will look for varicoceles. They can be found easily with a physical exam.
Treatment depends on what's causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into 3 categories:
- Non-surgical therapy for Male Infertility
- Surgical Therapy for Male Infertility
- Treatment for Unknown Causes of Male Infertility
Male infertility can often be fixed with an outpatient procedure. These are done under general anesthesia or IV sedation. While pain after surgery is usually mild, recovery and follow-up vary. After varicocele repair, your health care provider should do a physical exam. This is to see if the vein is completely gone. Often the veins stay enlarged, since they are not removed during surgery but only closed off to prevent abnormal blood flow. Semen should be tested about every 3 months for at least a year, or until pregnancy. If your varicocele returns, or you stay infertile, ask your health care provider about ARTs.
Vasectomy reversals cause only mild pain after surgery. But expect an out-of-work recovery of 4 to 7 days. The chance for pregnancy depends on many things. It mostly depends on the age and fertility of your female partner. The number of years between your vasectomy and reversal also affects success. The longer you wait, the less likely the reversal will be a success.
Frequently Asked Questions
What health problems can cause male infertility?
Many health problems--from kidney disease to testicular cancer--can result in male infertility. "Whole-body" health problems and metabolic disorders, and ordinary fevers and infections can harm sperm growth. Diseases passed through sex can lead to blocks and scars in the reproductive tract.
Genetic health problems, such as cystic fibrosis can cause the vas deferens or seminal vesicles to be absent leading to no sperm in the semen. Many illnesses can cause infertility. It's important that you and your partner tell your family and personal health histories to your health care provider.
Can cigarette smoke affect sperm?
Yes. Research shows that routine smoking affects sperm in many ways. It causes sperm cells to be smaller and slower. It harms their DNA. Smoking can also affect the seminal fluid ejaculated with sperm.
Can using steroids for body building cause infertility?
Do abnormal semen analyses or sperm lead to children with birth defects?
What's the main thing I should know about male infertility?
Infertility is not your or your partner's fault. The American Society of Reproductive Medicine (ASRM) estimates that in about a third of infertility cases it is due to the male. Another third is the female. In the last third of infertile couples, the problem is caused by either a combination of reasons, or, in 20 out of 100 cases, it can't be explained.
In men, few or no sperm is the biggest problem. In women, the common problems are ovulation problems and blocked tubes. But today, technology and surgical tools exist to address many of these problems.
What are assisted reproductive techniques (ARTs)?
If I have obstruction causing no sperm in the ejaculate (obstructive azoospermia), when should my partner and I consider sperm retrieval with an assisted reproductive technique (ART) rather than surgery?
Often, microsurgical correction removes the need for ART. However, if that is not successful, sperm can be removed from the testicle or epididymis and injected into your partner’s eggs using ICSI, even after surgery to fix the blockage. ICSI is used because the number of motile sperm is often small and they don't move well. There are many methods for retrieving sperm cells. The choice will be up to you and your urologist. Sperm retrieval can be done before or at the same time as your partner's egg retrieval and IVF.
Many reproductive centers like to use "fresh" sperm retrieved on the same day as egg retrieval. Others favor sperm harvested earlier and frozen. Sperm can be retrieved by needle aspiration or microsurgery.
If I have a varicocele, when should my partner and I consider an assisted reproductive technique (ART) rather than surgery?
- the female partner's age and ovarian function, and whether ART may be needed even if varicocele repair is done
- the chance that a varicocele repair may not definitely fix your fertility
- the fact that ART is needed for each try at pregnancy if the varicocele is not repaired
- data showing that a varicocele repair may help IUI and IVF results
Varicocele repair should be preferred if you don't have ideal semen but your partner is fertile. On the other hand, IVF, with or without ICSI, should be the first choice when there's a special need for such methods to treat a woman's infertility.
Are there risks with IVF/ICSI?
Yes, some risks exist, mostly for women. Mild ovarian hyperstimulation occurs in up to 10 to 20 out of 100 women who have IVF. It is caused by the hormones used in IVF/ICSI. Most women with mild cases tolerate symptoms well. There is moderate hyperstimulation in 5 out of 100 women having IVF. But severe hyperstimulation can cause high blood pressure, fluid build-up, sadness, weakness, and other symptoms. These symptoms need to be treated in the hospital. Only 1 out of 100 women having IVF suffer from severe hyperstimulation. This form can cause serious health problems.
Multiple births are also possible with IVF/ICSI. In the United States, after IVF there is a 10% to 20% risk for twins and less than 1% risk for triplets or more.
Are the pituitary tumors that cause low gonadotropin or raised prolactin levels malignant tumors (cancer)?
Should I try empiric hormonal therapy if I also have a varicocele?
In light of the harmful effects of oxidants on sperm function, should all infertile men take the antioxidant vitamin E?
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Source: Urology Care Foundation.