Definition

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

Men are considered infertile if they:

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

Causes

The Male Reproductive System

Copyright © Nucleus Medical Media, Inc.

Portions of the brain called the pituitary gland and hypothalamus, as well as male reproductive organs such as testes affect fertility in men. Problems in any of these areas may decrease fertility.

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

• Genetics diseases (such as, 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 (such as, sickle cell anemia)
• Excessive physical activity
• Anti-sperm antibodies

Risk Factors

These factors increase your chance of developing infertility:

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

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

Symptoms

Inability to have a child after one year of trying to conceive.

Diagnosis

During the first visit, you and your partner will both be evaluated. The doctor will ask about symptoms, medical history, and work history. Your doctor will look for potential exposure to certain chemicals. Your doctor will also 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 testicular 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.

Prevention

Infertility cannot always be prevented; however, 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.