Male Infertility & Reproductive Endocrinology
Introduction
Male infertility happens for numerous reasons. There may be a problem or problems with the man's sperm quality or quantity, including a low number of sperm (low sperm count), malformed sperm, sperm that does not move or move enough, or blockages in the routes that sperm travel. Additionally, lifestyle choices and health issues can contribute to male infertility.
It is important for both the male and female in a couple experiencing infertility to be assessed. Advances in reproductive medicine can make having children a reality for some infertile couples. Although certain causes of female or male infertility cannot be changed, some causes of can be corrected. Further, fertility may be assisted through artificial reproductive technology (ART).
Anatomy
Sperm travel from the testicles in coiled tubes to the epididymis, where they fully develop. From the epididymis, the sperm travel through the sperm duct (vas deferens) and combine with seminal fluid (produced by the seminal vesicles and the prostate gland) to form semen when a male is sexually stimulated. During sexual stimulation, the penis becomes erect and the semen exits the penis, through the urethra, during ejaculation.
Causes
• Age: After age 35 men experience a gradual decline in fertility
• Anti-sperm antibodies
• Blockages that prevent the travel of sperm
• Celiac disease (digestive disease with sensitivity to gluten food products)
• Certain medications: testosterone replacement therapy, long-term steroid use, chemotherapy, certain antibiotic medications, certain ulcer medications, certain anti-seizure medications
• Chromosomal abnormality
• Cigarette smoking
• Delayed or lack of ejaculation
• Emotional stress
• Erectile dysfunction
• Heavy alcohol consumption
• Heavy metal exposure: lead
• History of groin, testicle, penis, or scrotum problems or surgery
• Hormonal imbalance: Low testosterone
• Illegal drug use
• Illnesses & chronic health problems
• Infections (inflamed testicles due to mumps, inflamed prostate "prostatitis")
• Injury
• Low sperm production (low sperm count)
• Men who are underweight
• Men with obesity
• Misshapen sperm
• Overheating the testicles: saunas, hot tubs, tight clothing, seat pressure from prolonged bike riding
• Pesticide exposure: thylene dibromide, organophosphates
• Radiation can reduce sperm production & take several years to return to normal, high doses of radiation can permanently reduce sperm production
• Retrograde ejaculation (sperm moves to bladder instead of out from the penis)
• Sexually transmitted diseases that can cause impaired sperm health or scarring that blocks the passageway of sperm: Chlamydia, gonorrhea
• Sperm that do not move (immobile sperm)
• Undescended testicles
• Varicocele (swelling in testicle vein that keeps sperm too warm)
• Vitamin deficiency: Vitamin C, selenium, zinc, folate
Symptoms
Diagnosis
Your primary care doctor may make a diagnosis or refer you to a specialist, such as an urologist or reproductive specialist. Your doctor will review your medical history and perform an assessment. You should tell your doctor about any surgeries or injuries. It is common for a male to have more than one cause of infertility. The assessment process is individualized, and your doctor will let you know what to expect.
• Anti-sperm antibody tests
• Genetic testing
• Hormone evaluation including testosterone
• Physical examination
• Post ejaculation urinalysis- to determine if sperm move backward instead of forward (retrograde ejaculation)
• Specialized sperm function tests
• Sperm & semen analysis
• Testicular biopsy
• Ultrasound
• Vasography- to check for vas deferens blockage
Treatment
• Avoid tobacco smoking, marijuana, & cocaine
• Avoid alcohol, do not consume more than 2 drinks per day
• Avoid hot baths & whirlpools
• Avoid over-the-counter DHEA products for weight training
Medical
• Varicocele repair microsurgery
• Hormone medication
• Blockage correction surgery
Assisted Reproductive Techniques (ARTs):
• Intrauterine insemination (IUI): Sperm are injected into the woman's uterus at the time of ovulation
• In-vitro fertilization (IVF): Sperm from the man and eggs collected from the woman are placed together in the lab. Resulting fertilized eggs are placed in the woman's uterus.
• Intracytoplasmic sperm injection (ICSI): A single sperm collected from the man is injected into an egg collected from the woman in the lab. The resulting fertilized egg is placed in the woman's uterus.
Am I at Risk
Many factors can contribute to male infertility. Some risk factors cannot be changed, such as genetic conditions. Some of the risk factors that can be reduced include:
• Use of tobacco, marijuana, & cocaine
• Consuming more than 2 alcoholic drinks per day
• Hot baths & whirlpools
• Use of over-the-counter DHEA products for weight training
• The obese condition or the underweight condition
• Exposure to environmental toxins: pesticides, lead, radiation
Sexually Transmitted Diseases (STDs)
Copyright © - iHealthSpot Interactive - www.iHealthSpot.com
This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.
