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  Male Infertility
 
What are the key facts?

Approximately 15% of couples are unable to conceive a child after 1 year of regular, unprotected intercourse. This means that infertility affects about 6 million people in the United States.

A male factor for infertility may be involved in as many as half of all infertile couples. One common finding in affected men (40%) is the presence of varicoceles (enlarged veins within the scrotum). Azoospermia, the complete absence of sperm from the semen, is seen in approximately 10-15% of male infertility.

Infertility often results from reproductive problems in both partners. In 30-40% of these couples, the infertility involves both male and female factors. The inability to conceive due entirely to a male factor is seen in about 20% of infertile couples. On the other hand, in about 30-40% of infertile couples, the infertility is due to a female factor alone. Therefore, it is important that they work together as a team. In about 10% of these couples, neither partner has a detectable abnormality.

At present, in approximately 75% of cases of male infertility, potential underlying causes can be identified and usually some form of therapy can be offered.

How are sperm produced?

The functions of the male reproductive system are to produce sperm, store sperm, and transport sperm to the outside of the body. This process is complex and is regulated by a number of hormones.

The organs that produce sperm are called the testes (testicles). Most men have 2 testes. They are located in the scrotum, the pouch of skin that hangs below the penis. The testes are also the major producers of the male hormone, testosterone.

Sperm production begins with immature sperm cells. Sperm maturation occurs over a period of several months as they travel through the accessory organs of the male reproductive system. The main organ in this process is called the epididymis, a coiled tubule located behind the testis. During the climax (orgasm), the semen, the fluid that contains the sperm, is ejaculated.

The development and transportation of mature, functional sperm depend on a specific sequence of events. A proper evaluation often can help determine the location of your particular problem.

What are some common types of male infertility?

There are many possible causes of male infertility. Some of the more common types include:
  1. problems with sexual timing and/or techniques
  2. problems with erections and other sexual functions
  3. problems with ejaculation (the sperm are produced but the semen doesn't come out)
  4. "low sperm count" or oligospermia
  5. the complete absence of sperm from the semen or azoospermia
What is the purpose of an evaluation for Male Infertility?

First and foremost, getting an evaluation may allow you and your partner to better understand the basis of your infertility. Male infertility can be due to a variety of conditions, most are correctable or treatable but some are not reversible.

Potentially correctable conditions can be treated with non-surgical and/or surgical means and may allow for conception to occur through intercourse.

In other cases, the cause can be found but cannot be corrected. Conditions that not reversible or correctable but have adequate sperm can be treated with assisted reproductive techniques (ART) such as artificial insemination or in vitro fertilization.

Some of the uncorrectable causes cannot be treated in any way. For conditions that are not reversible and have inadequate sperm, donor insemination or adoption are possible options.

An evaluation may also identify genetic abnormalities that may affect the health of your offspring or unusual underlying, life-threatening medical conditions that require immediate medical attention.

It is important to know as much as you can about your condition so that informed decisions can be made about specific treatment and management options.

When should you have an evaluation?

The male partner of an infertile couple should be evaluated for infertility if pregnancy fails to occur within 1 year of regular, unprotected intercourse.

For the following conditions or situations, an evaluation before 1 year is recommended.
  1. a known male factor, such as an undescended testicle or small testicle, is present.
  2. female infertility risk factors, such as age greater than 35 years, are present or suspected.
  3. the couple suspects that they may have a problem with their fertility potential.
  4. a man who does not have a current partner wants to know whether his fertility is normal.
Where can you get an initial evaluation?

The initial screening evaluation of the male partner may be performed by your primary care physician or a urologist.

A reproductive history will be taken. The types of questions that might be asked are:
  1. How often and when do you and your partner have sexual intercourse?
  2. How long have you been having unprotected intercourse?
  3. Have you ever initiated a pregnancy before?
  4. Do you have any medical illness (such as diabetes, upper respiratory disease, etc)?
  5. Are you taking any medicines?
  6. Do you have trouble with erections?
  7. Have you ever been exposed to substances that could decrease fertility?
  8. What childhood illnesses have you had?
A semen analysis is the single most important laboratory test of an infertility evaluation. It helps to determine how severe the male infertility factor is. The test needs to be performed at least twice to confirm any diagnosis. Proper collection of semen is critically important. In most cases, a 2-3 day period of abstinence prior to collecting the semen specimen is recommended. Whether collected at home or at the laboratory, semen should be available for examination within 1 hour.

What follows the initial screening?

Typically, you will be referred to a urologist or other specialist in male reproduction if the initial evaluation reveals an abnormal reproductive history or an abnormal semen analysis. For couples with a treated female factor and persistent infertility, the male partner should be considered for a more detailed evaluation. Referral is also indicated for couples with un-explained infertility, which is when both partners have been evaluated, nothing is noted to be abnormal, yet pregnancy does not occur.

What are some of the specialized tests?

A physical exam by a urologist with focus on the male reproductive tract remains an important diagnostic tool. There are other means used to study your particular problems including post-ejaculatory urinalysis, hormonal tests, ultrasound studies, specialized tests on sperm, testicular biopsy, other x-rays studies, and genetic testing.

A final Note

The goal of getting an evaluation is to find the factor(s) causing your infertility. At present, in approximately 75% of cases of infertility, potential underlying causes can be identified and treated.

Sometimes, the specific cause of an abnormal semen analysis cannot be found. In about 20-30% of men who have had complete work-up, the cause of their infertility remains unknown. For these couples, assisted reproductive techniques may be suggested.

An evaluation is necessary to give you as much information as possible so that you can make the best choices for your future.

*  This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information.

 
 

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