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Male Infertility

Alternate Names

  • infertility due to male factors

Definition

Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Male infertility means the male is unable to impregnate the female because of male factors.

What is going on in the body?

The inability to get pregnant may be caused by conditions in either partner. Although in some couples no cause is ever found, it is estimated that 30% of infertility is caused by male factors. An additional 30% is caused by female factors, while the remaining 40% is caused by a combination of female and male factors.
Male infertility may be caused by many diseases, conditions, and other factors. Situations that raise the temperature in the testicles can interfere with normal sperm production.

Risks

What are the causes and risks of the condition?

There are many male factors that can make a couple unable to become pregnant. These may include conditions such as the following:
  • diabetic neuropathy, in which nerve damage causes problems with erection or ejaculation
  • extreme obesity
  • hormone imbalances, such as hypothyroidism
  • hypogonadism, a condition in which the testes fail to develop normally
  • inherited conditions that impair the ability to produce sperm, such as Down syndrome
  • testicular torsion, a condition in which the blood supply to the testicle is cut off
  • undescended testicles, a condition in which the testes fail to drop into the scrotum
  • varicocele, a group of enlarged veins inside the scrotum
Diseases also can be a factor in infertility, for example:
  • autoimmune disorders, which can cause the body to produce antibodies that attack sperm
  • liver disease
  • sickle cell anemia
  • kidney disease
  • genital infections such as gonorrhea and genital herpes
  • infections of the reproductive organs, such as prostatitis and epididymitis
  • other infectious diseases, including mumps
Additional factors in infertility include the following:
  • certain medications, such as cimetidine and phenytoin
  • certain supplements, such as anabolic steroids
  • chemotherapy used for cancer
  • diet low in folic acid or low in lycopene, which is found in plants such as tomatoes
  • excessive exercise, which lowers testosterone levels and decreases sperm production
  • exposure to diethylstilbestrol, also known as DES, as an infant in utero
  • exposure to toxins such as lead, mercury, or pesticides
  • frequent hot baths or use of hot tubs
  • injury to the testicles
  • low sperm count, poor sperm quality, and poor movement of sperm
  • radiation therapy
  • use of recreational drugs, such as alcohol, methadone, and marijuana
  • sexual problems, such as erectile dysfunction and premature ejaculation
  • side effects of treatments for testicular cancer or prostate cancer
  • surgery of the reproductive system, such as transurethral resection of the prostate
  • vasectomy, a surgical procedure to tie off the sperm-carrying tubes
  • wearing tight-fitting pants and underwear
  • work that requires prolonged sitting, which increases the temperature in the scrotum
A recent study has found that baby boys who wear diapers lined with plastic have significantly higher temperatures inside the testicles. The researchers suggest that disposable diapers may have contributed to the increase in male infertility over the past 25 years.

Prevention

What can be done to prevent the condition?

Some cases of male infertility may be avoided by doing the following:
  • Avoiding drugs and medications known to cause fertility problems.
  • Avoiding excessive exercise.
  • Avoiding exposure to environmental hazards such as pesticides.
  • Avoiding frequent hot baths or use of hot tubs.
  • Avoiding tight underwear or pants.
  • Eating a diet with adequate folic acid.
  • Getting prompt treatment for sexually transmitted infections.
  • Having regular physical examinations to detect early signs of infections or abnormalities.
  • Keeping diseases, such as diabetes and hypothyroidism, under control.
  • Practicing safest sex or safer sex to reduce one's risk for sexually transmitted infections.
  • Taking a lycopene supplement.
  • Wearing protection over the scrotum during athletic activities.
Although more research needs to be done, parents may want to consider alternatives to disposable diapers for male infants.

Diagnosed

How is the condition diagnosed?

The diagnosis of infertility begins with a medical history and physical exam. The provider may order blood tests to look for hormone imbalances or disease. A semen sample is usually needed in order to assess the volume of semen, the number of sperm in the sample, and how well they move..

Long Term Effects

What are the long-term effects of the condition?

Male infertility can create tension in a couple's relationship. Sexual relations may become less pleasurable. Fertility evaluations can be expensive. Eventually, 85% of couples find a cause for their inability to conceive. However, some couples never become pregnant, even with the newest treatments. Adoption may be the best choice in some cases.

Other Risks

What are the risks to others?

Male infertility is not contagious. However, male infertility can be caused by a sexually-transmitted infection, which may be transmitted to sexual partners.

Treatments

What are the treatments for the condition?

Treatment of male infertility focuses on the underlying cause. Without treatment, 15% to 20% of infertile couples will eventually get pregnant. Treatment for a male with infertility may include:
  • avoiding extended periods of time in hot baths and hot tubs
  • eating a healthy diet and exercising in moderation
  • having a varicocele surgically repaired
  • having vasectomy reversal surgery, which reconnects the tubes carrying sperm from the testes
  • learning about the best times to conceive
  • making lifestyle changes, such as smoking cessation and limiting intake of alcohol
  • taking antibiotics for any diagnosed infection
  • taking hormone therapy
  • treating erectile dysfunction with counseling, medication, or surgery
  • wearing loose-fitting underwear, such as boxer shorts
If these treatments don't work, other means of fertilization may be considered, such as:
  • artificial insemination. This involves placing sperm directly in the cervix or uterus as a medical procedure.
  • in vitro fertilization (IVF). This involves fertilizing the egg with sperm in a laboratory, then returning the resulting embryo to the woman's uterus as a medical procedure.
  • intracytoplasmic sperm injection. This version of IVF involves placing the individual sperm cells directly inside the woman's eggs in the laboratory, rather than just together in the same dish.

Side Effects

What are the side effects of the treatments?

Surgery can be complicated by bleeding, infection, or a reactions to the anesthetic. In vitro fertilization increases the chance of having a multiple pregnancy, such as twins. Antibiotics and other medications may cause stomach upset, diarrhea, or an allergic reaction.

After Treatment

What happens after treatment for the condition?

Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

Monitor

How is the condition monitored?

The man can monitor his own ability to impregnate a woman. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

The Merck Manual of Medical Information, Home edition, 1997

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.

Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

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