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Infertility in Men

Definition:
A couple is considered infertile if they cannot conceive after a full year of regular, unprotected sex. About one-third of all cases are caused by male factors. An equal number are caused by factors in the female. In the remaining cases the cause is unknown or is due to problems with both partners.

Causes:
Men are considered infertile if they produce too few sperm cells, sperm cells of poor quality, or have chronic problems with ejaculation.

It is not always possible to identify the cause of problems with sperm quality, quantity, or ejaculation. Some factors that can contribute include:

  • Genetics
  • Exposure to some workplace chemicals or heavy metals (primarily lead and cadmium)
  • Tobacco use
  • Marijuana use
  • Varicose veins of the testes (varicocele)
  • Abnormal hormone levels
  • Infections
  • Physical abnormalities
  • Cancer
  • Medications
  • Obesity
  • Excessive physical activity
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for male infertility include the following:
  • Exposure to toxic chemicals or heavy metals, such as lead
  • Liver disease
  • Nicotine use
  • Long-term marijuana use or cocaine use
  • Anabolic steroid use
  • Opiate use
  • Use of certain prescription drugs
  • Exposure to diethylstilbestrol (DES) in the womb
  • Chemotherapy
  • Smoking
  • Malnutrition
  • Overheating of the testicles
  • Cystic fibrosis
  • Klinefelter syndrome
  • Kartagener's syndrome
  • Diabetes
  • Spinal cord injuries
  • Multiple sclerosis
  • Brain tumors, pituitary gland tumors
  • Radiation treatment
  • Past infections, including sexually transmitted diseases, mumps, prostatitis
  • Birth defects of the male reproductive system, including history of undescended testicles
Symptoms:
A couple should seek help for infertility if they are unable to conceive after one year of trying. They will both be evaluated to determine if the infertility is due to the male, the female, or a combination of both.

Diagnosis:
During the initial consultation, both partners will be evaluated for fertility problems. The doctor will ask about any symptoms and your medical history, and perform a physical exam. During the physical exam, your doctor will look for varicoceles and any physical abnormalities that might cause infertility. Basic urine and blood tests will be performed. An occupational history can help your doctor determine if chemicals at the worksite could play a role.

The key test that will be performed is a semen analysis. The sample will be examined for the:

  • Amount of semen
  • Consistency of semen
  • Number of sperm
  • Movement of sperm
  • Shape of sperm
  • "Clumping" of sperm
  • Presence of substances other than sperm in the semen

Other tests may include :

  • Ultrasound–a test that uses sound waves to examine structures inside the body
  • X-ray–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 egg
  • Biopsy–removal of a sample of testicle tissue for testing
  • Blood tests for hormone evaluation and the presence of anti-sperm antibodies
  • Post-coital test to check if your sperm is compatible with the mucus in your partner's cervix
Treatment:
Treatment will depend on the cause of the infertility. Infertility treatments can be costly and lengthy. They often are not covered by insurance. Be sure to check with your insurance company.

Lifestyle Changes :
Your healthcare provider may suggest that you first try to make some changes such as:
  • Change the timing of sexual activity.
  • Avoid excessive heat (steam rooms, saunas).
  • Avoid tobacco, marijuana, and excessive alcohol use.
  • Wear looser fitting shorts and pants.
  • Maintain a healthy weight.
  • Try to decrease stress in your life. Learn stress reduction techniques.
Medication
Hormonal imbalances can be treated with medications.

Surgery
Surgery is sometimes performed to correct structural abnormalities.

Assisted Reproductive Technologies (ART)
ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from the couple or can be donated. ART methods include:

Artificial Insemination–Semen is collected and processed in a lab and 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 laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's uterus.

Gamete or Zygote Intrafallopian Transfer (GIFT or ZIFT)–An egg is removed from the woman's body and mixed with sperm in a laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's fallopian tube.

Blastocyst Intrafallopian Transfer–An egg is removed from the woman's body, injected with sperm, and allowed to develop to an embryonic stage called the blastocyst. This multi-celled blastocyst is implanted into the woman's uterus.

Intracytoplasmic Sperm Injection–A single sperm is actually injected into the egg, rather than just combined with the egg. The resulting embryo can be implanted into the woman's uterus, or frozen for later use.

Prevention:
Infertility cannot always be prevented. But the following steps may help:
  • Avoid use of tobacco, marijuana, opiates, and anabolic steroids.
  • Avoid exposure to harmful chemicals and heavy metals.
  • Avoid excessive use of alcohol.
  • Protect yourself from sexually transmitted disease by using condoms and minimizing the number of sexual partners.
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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