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Infertility is the inability to conceive after at least one year of unprotected intercourse. Since most people are able to conceive within this time, physicians recommend that couples unable to do so be assessed for fertility problems.
In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they persist without treatment. |
Common causes for male infertility are impaired sperm production, impaired sperm delivery, and testosterone deficiency (hypogonadism).
- Wash the scrotum to help prevent infection. (Some urologists also instruct patients to shave the front of the scrotum.)
- Bring a pair of tight-fitting underwear or athletic supporter to support the scrotum and minimize swelling.
- Arrange for a ride home to minimize exertion and movement that can exacerbate swelling.
- Avoid anti-inflammatory drugs, such as ibuprofen and aspirin. (These medications "thin" the blood and can cause excessive bleeding.)
Infertility can result from a condition that is present at birth (congenital) or can develop later (acquired). Causes for infertility include the following:
- Chemotherapy
- Defect or obstruction in the reproductive system (e.g., cryptorchidism, anorchism)
- Disease (e.g., cystic fibrosis, sickle cell anemia, sexually transmitted disease [STD])
- Hormone dysfunction (caused by disorder in the hypothalamic-pituitary-gonadal axis)
- Infection (e.g., prostatitis, epididymitis, orchitis)
- Injury (e.g., testicular trauma)
- Medications (e.g., to treat high blood pressure, arthritis)
- Metabolic disorders such as hemochromatosis (affects how the body uses and stores iron)
- Retrograde ejaculation (i.e., condition in which semen flows backwards into the bladder during ejaculation)
- Systemic disease (e.g., high fever, infection, kidney disease)
- Testicular cancer
- Varicocele
Varicoceles are dilated veins draining the testicles. Varicoceles are common in up to 15% o young adult males. However it may be found in up to 40% of subfertile males. Varicoceles may cause failure of testicular growth and development, symptoms of pain and discomfort and infertility.
Diagnosis is made by physical examination and confirmed by colour Doppler ultrasound.
Classification of varicocele:
Subclinical: Not palpable or visible at rest or during Valsalva manoeuvre, but demonstrable by special tests (reflux found upon Doppler examination)
Grade 1: Palpable during Valsalva manoeuvre but not otherwise
Grade 2: Palpable at rest, but not visible
Grade 3: Visible and palpable at rest
The search for the cause of infertility usually begins with the male, because male examination and testing is less complicated. A thorough examination and a review of the man's medical and surgical history are necessary, because chronic disease, pelvic injury, childhood illness, abdominal or reproductive organ surgery, recreational drug use, and medications can affect fertility. Physical examination may detect testicular irregularities (e.g., vericocele, absence of vas deferens, tumor), evidence of hormonal disorders (e.g., underdeveloped reproductive organs, enlarged breast tissue), or evidence of testosterone deficiency.
Assessing reproductive-fertility history is important; specialists typically inquire about the following:
- Early puberty (may result from hormonal disorder)
- Late puberty (may result from Kallmann's syndrome)
- Previous pregnancy
- Sexual intercourse timing (understanding ovulation)
- STDs (can cause scarring, obstruction)
- Use of lubricants (may kill sperm)
At least one-half of male fertility problems can be treated so that conception is possible. There are three categories of treatment for male infertility:
- Assisted reproduction
- Drug therapy
- Surgery
Assisted reproduction therapy includes methods to improve erectile dysfunction, induce ejaculation, obtain sperm, and inseminate an egg:
- Electroejaculation
- Sperm retrieval and washing
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Gamete intrafallopian transfer (GIFT)
