Description

Almost 1 out of every 7 couples are infertile, which means they have not been able to conceive a child despite the fact that he has had frequent, unprotected sexual intercourse for a year or more. In half of these couples, male infertility plays at least a partial role.

Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle and other factors can contribute to male infertility.

The inability to conceive a child can be stressful and frustrating, but a number of treatments for male infertility.

Symptoms

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms.

In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm causes signs and symptoms. The signs and symptoms you may notice include:

  • Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, decreased sex drive or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling, or a lump in the testicle area
  • Recurrent respiratory infections
  • Inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

When to see a doctor

Consult a doctor if you have been unable to conceive a child after one year of regular, unprotected intercourse or sooner if you have any of the following:

  • The erection or ejaculation problems, low sex drive, or other problems with sexual function
  • The pain, discomfort, a lump or swelling in the testicle area
  • A history of testicle, prostate or sexual problems
  • A groin, testicle, penis or scrotum surgery
  • A pair of over 35 years of age

Causes

Male fertility is a complex process. To get your partner pregnant, the following must occur:

  • You must produce healthy sperm. Initially, this involves the growth and development of the male reproductive organs during puberty. At least one of your testicles should be working properly, and the body needs to produce testosterone and other hormones that trigger and maintain the production of sperm.
  • The sperm have to be carried in the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
  • There must be enough sperm in the semen. If the number of sperm in the semen (sperm) is low, it decreases the odds that one of your sperm will fertilize your partner's egg. A low sperm count is less than 15 million sperm per milliliter of semen or less than 39 million per ejaculate.
  • The sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner's egg.

Medical causes

Problems with male fertility can be caused by a number of health problems and medical treatments:

  • Varicocele. A varicocele is a swelling of the veins that drain the testicles. It is the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to the abnormal flow of blood. Varicoceles lead to the reduction of the quantity and quality of sperm.
  • Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
  • Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging from the tip of the penis. Several health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
  • Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
  • Tumors. Cancers and malignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland or to unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect the male fertility.
  • Undescended testes. In some males, during fetal development one or both testicles do not descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
  • Hormonal imbalances. Infertility can result from disorders of the testicles, or an abnormality affecting other hormonal systems, including the hypothalamus, pituitary, thyroid and adrenal glands. Low levels of testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
  • Defects of tubules that transport sperm.Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as cystic fibrosis or similar inherited conditions. The obstruction can occur at any level, including within the testicle, in the tubes that drain the testes, the epididymis, the vas deferens, near the ejaculatory ducts or in the urethra.
  • The chromosomal abnormalities. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and a y chromosome instead of one X and one y) — cause abnormalities in the development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, and Kallmann syndrome.
  • Problems with sex. These can include difficulty maintaining or maintain an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities, such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
  • The celiac disease. Celiac disease is a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to male infertility. Fertility may improve after adopting a gluten-free diet.
  • Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some ulcer drugs, some arthritis drugs and certain medications may affect the sperm production and decrease male fertility.
  • Before the surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as cystic fibrosis or similar inherited conditions.

The obstruction can occur at any level, including within the testicle, in the tubes that drain the testes, the epididymis, the vas deferens, near the ejaculatory ducts or in the urethra.

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

  • Industrial chemicals. Prolonged exposure to certain chemicals, pesticides, herbicides, organic solvents and painting materials can contribute to low sperm counts.
  • Heavy metal exposure. Exposure to lead or other heavy metals can also cause infertility.
  • Radiation or x-rays. exposure to radiation can reduce sperm production, although often with the time, to get back to normal. With high doses of radiation, sperm production can be permanently reduced.
  • The overheating of the testes.High temperatures may affect sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily affect the sperm count. Sitting for long periods of time, wearing tight clothing or working on a laptop for long periods of time also may increase the temperature in the scrotum and may slightly reduce sperm production. But, the research is not conclusive.

The overheating of the testes. High temperatures may affect sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily affect the sperm count.

Sitting for long periods of time, wearing tight clothing or working on a laptop for long periods of time also may increase the temperature in the scrotum and may slightly reduce sperm production. But, the research is not conclusive.

Health, lifestyle and other causes

Some other causes of male infertility are:

  • The use of drugs. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. The use of cocaine or marijuana may temporarily reduce the number and the quality of your sperm as well.
  • The consumption of Alcohol. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Disease of the liver caused by the excessive consumption of alcohol can also lead to fertility problems.
  • Tobacco smoking. Men who smoke may have a lower sperm count than those who do not smoke. The second-hand smoke can also affect male fertility.
  • Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves, as well as by causing hormone changes that reduce male fertility.

Risk factors

Risk factors linked to male infertility include:

  • Smoking tobacco
  • The use of alcohol
  • The use of certain illegal drugs
  • Overweight
  • Having been found in the past or present infections
  • Be exposed to the toxins
  • The overheating of the testicles
  • After having experienced the trauma to the testicles
  • Have a prior vasectomy or major abdominal or pelvic surgery
  • Having a history of undescended testes
  • Born with a disorder of fertility or having a blood relative with a disorder of fertility
  • Have certain medical conditions, including tumors and chronic diseases, such as sickle cell disease
  • Taking certain medications or undergoing medical treatments, such as surgery or radiation that is used for the treatment of cancer

Complications

Complications of male infertility can include:

  • Stress and relationship difficulties related to the inability to have a child
  • Expensive and involved in the reproduction techniques
  • Increased risk of testicular cancer, melanoma, colon cancer and prostate cancer

Prevention

Male infertility is not always avoidable. However, you can try to avoid some of the causes of male infertility. For example:

  • Do not smoke.
  • Limit or abstain from alcohol.
  • Stay away from illicit drugs.
  • Maintain a healthy weight.
  • Do not get a vasectomy.
  • Avoid the things that lead to the prolonged heat to the testicles.
  • Reduce stress.
  • Avoid exposure to pesticides, heavy metals and other toxins.

Diagnosis

Many infertile couples have more than one cause of infertility, so it is very likely that you both need to see a doctor. It might take a series of tests to determine the cause of the infertility. In some cases, a cause is not identified.

The infertility tests can be expensive and could not be covered by the insurance — find out what your medical plan covers before your time.

The diagnosis of male infertility problems usually involves:

  • In General, the physical examination and medical history. This includes examination of your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor also may ask about your sexual habits, and about their sexual development during puberty.
  • Semen analysis. Semen samples can be obtained in a couple of different ways. You can give an example of by masturbating and ejaculating into a special container at the doctor's office. For religious reasons or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, the semen can be collected through the use of a special condom during sex.

His semen is sent to a lab to measure the number of sperm present and to look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The laboratory will also check your cum for signs of problems such as infections.

Often the number of sperm that fluctuate significantly from one sample to the next. In most cases, several semen analysis tests over a period of time to ensure the accuracy of the results. If the semen analysis is normal, your doctor will probably recommend thorough testing of his partner before the execution of most of the male infertility tests.

Your doctor may recommend additional tests to help identify the cause of your infertility. These may include:

  • Ultrasound of the scrotum. This test uses high-frequency sound waves to produce pictures of the inside of your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and the supporting structures.
  • The Transrectal ultrasound. A small, lubricated wand is inserted into the rectum. This allows your doctor to check your prostate and look for blockages in the ducts that carry the sperm.
  • The hormone test. The hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormones or organ systems can also contribute to infertility. A blood test that measures the level of testosterone and other hormones.
  • Post-ejaculation urine analysis. The sperm in the urine may indicate the semen travels backwards into the bladder instead of out through the penis during ejaculation (retrograde ejaculation).
  • The genetic testing. When the sperm concentration is very low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the chromosome, And the signs of a genetic anomaly. Genetic tests may be ordered to diagnose a variety of congenital or hereditary syndromes.
  • Testicular Biopsy. This test involves removing samples of the testes with a needle. If the results of the testicular biopsy show that the production of sperm is normal, the problem is likely caused by a crash or some other problem with the transport of sperm.
  • Specialized sperm function tests. A series of tests you can use to check how your sperm survive after ejaculation, how well you can penetrate an egg, and if there is any problem of attachment to the egg. These tests are not often used and usually does not significantly change recommendations for treatment.

Treatment

Often, the exact cause of the infertility cannot be found. Although the exact cause is not clear, your doctor may be able to recommend treatments or procedures that lead to conception.

In cases of infertility, it is recommended that the partner of the woman will also be evaluated. There may be specific treatments recommended for your partner. Or, you can learn that you continue with assisted reproduction techniques is appropriate in your situation.

Treatments for male infertility include:

  • Surgery. For example, a varicocele can often be surgically corrected or obstruction of the vas deferens repaired. Before the vasectomy can be reversed. In cases where no sperm present in the ejaculate, sperm can often be retrieved directly from the testicles or the epididymis, the use of techniques of recovery of sperm.
  • The treatment of infections. Treatment with antibiotics can cure an infection in the reproductive tract, but not always restore fertility.
  • Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
  • Hormone treatments and medications. Your doctor may recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
  • The assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from individuals, depending on their specific case, and desires. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

When the treatment does not work

In rare cases, male fertility problems can't be treated, and it is impossible for a man to father a child. Your doctor may suggest that you and your partner, consider the use of donor sperm or adoption of a child.

Lifestyle and home remedies

There are some steps that you can take at home to increase your chances of achieving pregnancy:

  • Increase the frequency of sexual intercourse. Having sex every day or every two days beginning at least five days before ovulation increases your chances of getting your partner pregnant.
  • Have sex when fertilization is possible. It is likely that the woman can get pregnant during ovulation, which occurs in the middle of the menstrual cycle, between the periods. This will ensure that the sperm can live for several days, are present when conception is possible.
  • Avoid the use of lubricants. Products such as Astroglide or K-y jelly, lotions, and saliva can affect the movement of the sperm and the function. Ask your doctor about sperm-safe lubricant.
  • Live a healthy lifestyle. Eat a variety of healthy foods, maintaining a healthy weight, getting enough sleep, and exercising regularly.
  • Avoid the things that harm your health in general. Stop or reduce their alcohol consumption, quitting smoking and not using illicit drugs.

Alternative medicine

The evidence is limited on whether — or how — herbs, or supplements that can help increase male fertility. None of these supplements is a specific underlying cause of infertility, such as a sperm duct defects or chromosomal disorder.

The supplements with the studies that show the potential benefits to improve the sperm count or quality include:

  • Coenzyme Q10
  • The folic acid and zinc combination
  • L-carnitine
  • Selenium
  • Vitamin C
  • Vitamin E

Talk with your doctor before taking dietary supplements for male infertility. There is No clear evidence that they work, and some supplements can cause side effects or interact adversely with medications you take.

Coping and support

Coping with infertility can be difficult. It is a theme of the unknown — can't predict how long it will last or what the outcome will be. Infertility is not necessarily solved with hard work. The emotional charge of a couple is considerable, and plans for coping may help.

The planning for the emotional turmoil

  • Set limits. Decide in advance how many and what type of procedures are emotionally and financially acceptable for you and your partner, and determine a final limit. Fertility treatments can be expensive and often not covered by insurance.
  • Consider other options. Determine the alternative of adoption or a sperm donor or egg — as soon as possible in the process of fertility. This can reduce anxiety during treatments, and feelings of hopelessness if conception does not occur.
  • Talk about your feelings. Look for support groups or counseling services to help before and after your treatment to help support the process and relieve the pain if the treatment fails.

Management of emotional stress during treatment

  • The practice of stress reduction techniques. Examples include yoga, meditation, and massage therapy.
  • Consider going to counseling. Counseling, such as cognitive behavioral therapy, using methods that include relaxation training and stress management, can help to relieve stress.
  • Express yourself. Reach out to others instead of holding on to feelings of guilt or anger.
  • Stay in touch with their loved ones. Talk with your partner, family and friends can be helpful.

Preparing for your appointment

If you have never been evaluated by a doctor, you could start by seeing your family doctor. However, if you have a known condition that results in infertility or have any abnormalities in tests for your primary care doctor, then you may be referred to a specialist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do beforehand. If a semen analysis is scheduled, you must abstain from ejaculating for at least two to five days before the collection.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Find out if you have a family history of fertility problems. Have a male blood relative, such as his brother or his father, with problems of fertility or other reproductive problems could give clues to the cause of fertility problems.
  • To know your parents, if you had undescended testicles or other problems at birth or in early childhood.
  • Make a list of all the medicines, vitamins, and supplements you are taking. This includes the previous use of the muscle-building substances, and any use of alcohol, tobacco, marijuana or other recreational drugs.
  • Take your partner along. Your partner may also need tests to check the fertility problems that could prevent pregnancy. It is also good to have your partner along to help you keep track of your doctor's instructions or ask questions you may not think of.
  • Write questions to ask their doctor.

Questions to ask your doctor

Examples of questions are:

  • What do you suspect might be interfering with my ability to be a parent of a child?
  • Other that the most likely cause, what are other possible reasons that my partner and I have not been able to conceive a child?
  • What kinds of tests do I need?
  • My partner also needs testing?
  • What is the best treatment for my disease?
  • What are the alternatives to the primary approach you're suggesting?
  • Are there any restrictions that I need to follow?
  • You should see a specialist?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend to visit?

Don't hesitate to ask additional questions at any time during your appointment.

What to expect from your doctor

Be prepared to answer the questions that your doctor is likely to ask, including:

  • At what age did you start puberty?
  • Has had sexual problems in this relationship, including the difficulty maintaining an erection, ejaculating too soon, or not be able to ejaculate?
  • Have you ever fathered a child?
  • He has had a vasectomy or other abdominal, pelvic or scrotal surgery?
  • Does the use of illicit drugs, such as marijuana, cocaine or anabolic steroids?
  • Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
  • Are you currently taking any medications, including dietary supplements?
  • Do you have a history of an undescended testicle?
Symptoms and treatment of Male infertility