McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is infertility?

Infertility is the failure of a couple to become pregnant after 1 year of having regular, unprotected sexual intercourse. It can be caused by problems in a man's or woman's reproductive system.

Infertility is a problem for one of every six couples. Problems in the male partner are responsible for about 50% of infertility cases.

How does male infertility occur?

Most often a man is infertile because he produces too few sperm or no sperm at all. Reasons for this may be:

• exposure to toxic chemicals or radiation
• a genetic disorder, such as Klinefelter's syndrome
• taking frequent, long, hot tub baths
• alcohol, tobacco, or drug abuse
• a severe mumps infection as an adolescent or adult
• hormone disorders of the pituitary gland, testicles, thyroid glands, or adrenal glands
• infections of the genital organs, causing blockage of the sperm passages
• wearing jockey shorts underwear all the time.

Sometimes the sperm are abnormal. That is, they are malformed and cannot swim properly or they have a short lifespan. A normal sperm has a lifespan of about 4 days. Abnormal sperm can result from:

• inflammation of the testicles (a possible complication of having mumps as an adult)
• abnormally twisted or swollen veins in the scrotum (varicocele), the sac that holds the testicles
• abnormally developed testicles.

Sometimes the problem is getting the sperm into the woman's vagina (ejaculation). Problems with ejaculation may include:

• early ejaculation
• retrograde ejaculation (semen is forced back into the bladder)
• inability to keep an erection (possibly due to side effects of some blood pressure medications or diseases such as diabetes or Peyronie's disease)
• a complication of radiation therapy or surgery.

Sometimes the problem is the natural decline in fertility that comes with aging, especially after age 40.

How is it diagnosed?

At first, you will both probably see a primary health care provider. You may then be referred to a specialist. Men usually see a urologist.

You and your partner will have thorough physical exams. You will be asked about:

• your sexual history, including previous pregnancies
• your history of medical conditions such as illnesses and infections
• use of drugs and alcohol
• sexual intercourse practices, such as how often you have sex and whether you use lubricants
• genital surgery
• circumcision
• genital development.

Your health care provider may order the following tests:

• a semen analysis to check the number and quality of sperm
• blood tests to check for infections from sexually transmitted diseases and for a hormone imbalance
• cultures of fluid from the penis to check for infections.

How is it treated?

If you have a disorder causing infertility, your health care provider will recommend treatment for it. Treatment may include medication (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments for both partners is necessary.

Possible treatments include:

• Taking hormones for a hormone imbalance.
• Taking drugs to stimulate sperm production.
• Taking an antibiotic to clear up an infection.
• Avoiding long, hot showers and frequent use of hot tubs and saunas. High temperatures can reduce your sperm count. It also may help to wear boxer shorts rather than jockey shorts.
• Having therapy to treat ejaculation problems.
• Having surgery to correct a disorder in the testicles or to remove a blockage of the tubes that carry the sperm.

If your sperm count is low, artificial insemination may be an option. The sperm is collected at several different times and stored until there is a sufficient amount. It is then placed in your partner's uterus or fallopian tubes during the most fertile time in her menstrual cycle. This procedure has varying success. If your sperm count is still too low or the sperm are not able to function properly, you may want to consider using sperm donated by another man.

In vitro fertilization is another option. In this procedure the egg is fertilized with sperm in the lab and then put into the woman's body. This procedure may be done if your sperm count is low or your partner's fallopian tubes are blocked or damaged and cannot be corrected with surgery. In vitro fertilization is expensive and success rates are often low.

The period of investigation and treatment for infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through any difficult times.

What can be done to help prevent male infertility?

You may not be able to prevent infertility resulting from genetic problems or an illness. However, you can do the following to reduce your risk of developing disorders that might cause infertility:

• Prevent sexually transmitted diseases by using latex condoms and having sex only with your partner.
• Limit the amount of alcohol you drink.
• Avoid the use of street drugs (such as heroin) and overuse of prescription and nonprescription drugs.
• Avoid exposure to toxic substances such as industrial chemicals, herbicides, and pesticides.
• Avoid exposure to excess radiation.
• Maintain good personal hygiene and health practices.
• Avoid long, hot tub baths and wearing jockey shorts.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.