Infertility and men

Infertility is defined as the inability to conceive after one year or more of regular, unprotected sexual intercourse. In the United States, about 15 percent of couples are considered infertile. Infertility affects men and women equally.


Anatomy
Male fertility depends on the production of healthy sperm in the testicles and their normal transport through the male reproductive tract. Sperm production is regulated by a delicate balance of hormones produced by the hypothalamus, pituitary, thyroid and adrenal glands, as well as in the testes themselves. After sperm are produced, they mature in a tightly coiled tube called the epididymis. From there, they're stored in a tube called the vas deferens.
Two additional organs attached to the reproductive tract, the seminal vesicles and the prostate gland, produce substances that mix with the sperm to form semen, the fluid that flows from the penis during ejaculation. The substances from these organs provide nutrients for the sperm and help protect the sperm from harm in the vagina.

Millions of sperm are deposited in the woman's vagina with each ejaculation. The sperm then travel through the fallopian tubes (the tubes located on each side of the woman's uterus that lead from the ovaries to the top of the uterus) toward the ovaries. Conception occurs when an egg and a sperm join together in the fallopian tube to form an embryo, which travels back through the fallopian tube and implants itself in the uterus.

Ovulation is the ripening and rupture of a mature egg from one of the ovaries (the female glands that produce female sex hormones and eggs for reproduction). Ovulation typically takes place midway through the menstrual cycle or about 14 or 15 days before the next menstrual cycle.

After leaving the ovary, an egg is capable of being fertilized for up to about 24 hours. Sperm are capable of fertilizing an egg for about 72 hours after ejaculation. Conception occurs when an egg and a sperm join together, usually in the fallopian tube, to form an embryo. The embryo travels through the fallopian tube and implants itself in the uterus.


Causes/associated factors
Fertilization depends on a series of complex events. For example, timing and frequency of sex are important for pregnancy to occur naturally. If you're trying to conceive, the best time to have sex is daily around the time your partner ovulates. Abstain from ejaculation for two to three days before the daily sex. To help target the best time to conceive each month, keep a diary of your sexual activity, as well as a log of when your partner is likely to be ovulating.
If you haven't conceived after a year, you and your partner may want to contact a doctor. If your partner is older than 35, you may want to consult a doctor after six months. If either partner has a health problem thattions, such as undescended testicles (a condition in which the glands that produce sperm and testosterone -- the male sex hormone -- don't descend into the scrotal sac during childhood; because testicles function best at a temperature lower than normal body temperature, they need to be in the scrotal sac to produce sperm)

birth defects affecting the reproductive tract
varicocele in the scrotum (veins that have reduced flow and become dilated)
prostate infections or surgical removal of the prostate gland
production of antisperm antibodies (compounds that help neutralize or destroy foreign substances in the blood) possibly following vasectomy, injury or infection
surgical removal of one or both testicles or the prostate gland
high fever after puberty
some chronic illnesses (including diabetes and multiple sclerosis)
sexually transmitted diseases (STDs)
other infections that may affect the testicles, such as mumps
exposure to chemicals, such as pesticides
anabolic steroid use
alcoholism or use of recreational drugs, including marijuana and cocaine
cigarette smoking
cancer chemotherapy
radiation exposure (occupational or related to cancer treatment)
injury to the genital area
certain abdominal or pelvic surgeries, including previous vasectomy
problems with erection or ejaculation
stress
long, hot showers or prolonged or frequent use of hot tubs or saunas
extended use of athletic supporters
mistimed or infrequent sexual intercourse
use of lubricants that kill sperm or inhibit their ability to swim, including KY jelly and Lubafax
Sometimes, there is simply no sperm in the semen, a condition called azoospermia. There are many possible causes of azoospermia, including physical obstructions, hormonal problems, or varicoceles. For many infertile couples, the cause of infertility is never identified.

Although men with infertility problems have traditionally been told to avoid wearing athletic supporters or jockey shorts because they may raise scrotal temperatures and harm sperm, there is little scientific research that shows this actually happens.


Diagnosis
Infertility is best diagnosed and treated by an infertility specialist (a doctor who is board certified in obstetrics, gynecology or reproductive endocrinology). The infertility specialist will want to initially evaluate both you and your partner together. Treatment should stress the importance of working through this emotional time as a couple. If the man is found to have a problem thatists' training and experience in evaluating and treating infertility.
Making the correct diagnosis regarding the cause of infertility is critical to finding the best treatment. The doctor will ask you and your partner about your health histories, past illnesses or injuries, medication use, sexual habits and basic lifestyle patterns. You'll both also need a complete physical exam.

A semen analysis is typically the initial screening test for men. You'll be asked to provide a semen sample after two to three days of abstaining from intercourse or ejaculation. Your sample will be analyzed for the amount and quality of sperm, including sperm abnormalities, sperm motility (the ability to move) and any evidence of infection. You may be asked to provide two or three semen samples at different times. If multiple samples are given, be sure to use an identical period of sexual abstinence before collecting each sample.

Rarely, certain diagnostic tests may be done if the results of other tests are abnormal, such as a needle biopsy of tissue from the testes. You may also need one or more of the following tests:

If a testicular biopsy finds healthy sperm but your semen analysis indicates that sperm are missing, the doctor may do a vasography (a special X-ray that involves injecting dye into the reproductive tract to determine if the vas deferens, the ducts that carry sperm to the urethra, are blocked).
A transrectal ultrasound (using sound waves to create images of internal body parts) can help the doctor see the prostate, seminal vesicles and vas deferens.
Hormone measurements may also be done to test certain hormones, including testosterone, pituitary hormones and thyroid hormones.
An antisperm antibody test may be recommended to determine if your own immune system is attacking your sperm. Your partner's blood and cervical mucus may also be checked for antibodies with this test.

Treatment
Treatment is aimed at correcting the cause of infertility to improve or restore fertility. If natural reproduction is not possible, alternative treatments and options are available. Before making a treatment decision, be sure to discuss the risks and benefits, success rates and how these rates are defined with your doctor. It's important to address any concerns, such as finding the right doctor, determining how much time and effort you're willing to commit to treatment and the cost. Also consider the emotional stress thatd and your available support system, as well as any other personal issues.
Lifestyle adjustments
If the problem is related to spending too much time in hot showers, hot tubs or saunas, simply avoid them. Avoid athletic supporters and lubricants that may affect the viability of your sperm. The problem may also be related to timing. If yount. Many researchers recommend having sex every day around the time of ovulation. Remember, however, it's best to abstain from ejaculation for two to three days before the daily sex.

Medication
Some causes of male infertility may be treated with medication. If you have hormone imbalances, medication may improve sperm production and motility. If you have retrograde ejaculation (when ejaculate empties into the bladder instead of the penis), your doctor may prescribe medications such as phenylpropanolamine Hcl, ephedrine sulfate, pseudoephedrine Hcl or imipramine Hcl. If your body is producing antisperm antibodies, corticosteroid medications or a type of assisted reproductive technology (ART) may be an option. Of course, the side effects of corticosteroids must be weighed against the chances of pregnancy with ART. There are many ART methods available. Success rates vary -- ask your doctor for details.

Surgery
The goal of surgery is to correct or reverse the cause of infertility. Remember, surgery cannot guarantee fertility. Ask your surgeon or doctor for details on success rates.

If you have a varicocele, surgery may be able to restore your fertility. The spermatic vein is tied off to improve semen quality. An experienced radiologist can also treat this condition nonsurgically using an X-ray to guide a thin tube through the vein after a needle puncture to reach the testes. Then, the vein can either be tied off with a coil or chemically treated. Surgery may also be done to correct problems such as undescended testicles or an obstructed duct or reverse a vasectomy. Discuss the options with your surgeon.

Surgery benefits: Successful surgery may result in pregnancy. The highest success rates for vasectomy reversal are with microsurgery.

Surgery risks: Infertility may continue. If the undescended testicles are abnormal, surgery will not correct the problem.


Considerations
People struggling with infertility may experience frustration, sadness and a loss of control, as well as symptoms of depression, guilt or shame. They may become obsessed or preoccupied by their infertility and efforts to get pregnant, often cycling between hope and despair. For some couples, the difficulty associated with infertility provides an opportunity to grow closer to each other. Others may need to grieve individually. You may find yourself withdrawing from personal relationships and focusing your energy on your career. In addition to medical treatment from an infertility specialist, mental health counseling may be helpful. Finding a supportive network of people you trust may help ease the depression and frustration of infertility, along with the ups and downs of treatment.

Prevention
In some cases, infertility can't be avoided or prevented. You can help preserve fertility, however, by making healthy lifestyle choices. For example, help protect yourself from sexually transmitted diseases by using condoms before you want to conceive a child. Remain in a mutually monogamous relationship or limit your number of sexual partners. Avoid exposure to toxic environmental or occupational substances, such as harsh chemicals, pesticides and herbicides. It's also helpful to avoid stress, long, hot showers and frequent use of hot tubs or saunas. Finally, limit alcohol use and avoid anabolic steroids, cigarettes and recreational drugs, including marijuana and cocaine.