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 cellsProduce sperm cells of poor qualityHave chronic problems with ejaculation
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,
, Sertoli-Leydig cell syndrome)
Exposure to some workplace chemicals or heavy metals (primarily lead and cadmium)Tobacco use
Varicose veins of the testes (
Abnormal hormone levelsInfectionsPhysical abnormalitiesCancerMedicationsObesity
Chronic diseases (such as,
sickle cell anemia
Excessive physical activityAnti-sperm antibodies
These factors increase your chance of developing infertility:
Exposure to toxic chemicals or heavy metals, such as
Nicotine use, long-term marijuana or
, and certain prescription drug use
Exposure to diethylstilbestrol (DES) in the wombChemotherapyMalnutritionOverheating of the testiclesCystic fibrosisKlinefelter syndromeKartagener syndromeDiabetesSpinal cord injuriesMultiple sclerosisBrain tumors
pituitary tumorsRadiation treatment
Past infections, including
sexually transmitted diseases
Birth defects of the male reproductive system, including history of
high body mass index
Tell your doctor if you have any of the above risk factors.
Inability to have a child after one year of trying to conceive.
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:
TestosteroneLuteinizing hormoneFollicle stimulating hormoneProlactin levelsSemen analysis
Amount of semenConsistency of semenNumber of spermMovement of spermShape of sperm"Clumping" of spermPresence of substances other than sperm in the semen
—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
—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 eggBiopsy
—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 depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.
If you have a hormonal imbalance, your doctor may prescribe medication.
(Clomid, Serophene), for example, is an anti-estrogen drug. In combination with vitamin E, it may help increase sperm count and improve sperm movement.
Surgery is done for conditions like varicocele that can affect fertility. Treatment of a varicocele does not always restore fertility.
Surgery may also be done to reverse
. This reversal is not always successful.
ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from you and your partner or donated. ART methods include: Artificial insemination—semen is collected and processed in a lab. It is then inserted directly into the woman's cervix or uterus.In vitro fertilization (IVF)
—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.Blastocyst intrafallopian transfer—an egg is removed from the woman's body. Egg is injected with sperm and allowed to develop. It is later implanted into the uterus.Intracytoplasmic sperm injection—a single sperm is injected into the egg. The resulting embryo can be implanted into the uterus or frozen for later use.
Infertility cannot always be prevented; however, the following steps may help:
Use of tobacco, marijuana, opiates, and anabolic steroidsExposure to harmful chemicals and heavy metalsExcessive use of alcohol
Protect yourself from STDs by using
. Minimize the number of sexual partners you have.
Jorgensen N, Carlsen E, Nermoen I, et al. East-West gradient in semen quality in the Nordic-Baltic area: a study of men from the general population in Denmark, Norway, Estonia and Finland.
Swan SH, Brazil C, Drobnis EZ, et al. Geographic differences in semen quality of fertile US males.
Environ Health Perspect
9/2/2009 DynaMed Systematic Literature Surveillance
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Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial.
2009 Mar 5. [Epub ahead of print]
2/14/2011 DynaMed's Systematic Literature Surveillance
: Showell M, Brown J, Yazdani A, Stankiewicz M, Hart R. Antioxidants for male subfertility.
Cochrane Database Syst Rev
Last reviewed December 2013 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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