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Male infertility

What is it?

Male infertility means that you have had regular sex for 1 year without birth control and your partner has not gotten pregnant. Birth control includes birth control pills, diaphragm, condoms, or rhythm. Infertility is not the same as being sterile. Being sterile is when you cannot get your partner pregnant and the cause cannot be fixed. Fifteen to 20% of healthy adults have fertility problems. With help, many fertility problems can be treated.

Following are some of the things that can interfere with a couple getting pregnant but are not causes of infertility.

  • Use of lotions during intercourse.
  • Position during intercourse.
  • Douching (rinsing the vagina) after intercourse.
  • Too frequent ejaculation.

Myths About Infertility: There are many myths or misinformation about the causes of infertility. Following are some of these myths and the real truth about infertility.

  • Infertility is a psychological problem. Actually, a physical problem is found to be the cause of 80 to 90% of all cases of infertility.
  • Being infertile is a sexual problem. In fact, most couples with impaired infertility do not have any problem having intercourse (sex).
  • Adopting improves a couple's chance of conceiving. Unfortunately, no improvement in fertility has been found in couples who adopted than in couples who did not adopt.
  • There are many other religious and cultural issues about infertility. Talk to your caregiver if you are worried about any of these or other myths about being infertile.

What is the male reproductive system and how does it work?

  • The urethra is a tube that runs from the bladder to the end of the penis . Both urine and semen leave the body through the urethra. Blood fills the cavities beside the urethra to make the penis erect while having intercourse.
  • The scrotum is the sac hanging behind the penis that holds the 2 testicles, the epididymis, and some of the spermatic cord. The testicles make sperm and the male hormone testosterone. Hormones are special chemicals made by your body that control how different parts of your body work. The epididymis is a long curled tube where the sperm grow and mature. The seminal vesicles make fluid to help the sperm grow while in the epididymis.
  • The vas deferens is a tube that carries the sperm from the epididymis to the prostate gland. The prostate gland makes the fluid that sperm moves in as it is excreted (pushed out) of the ejaculatory ducts . Cowper's glands put mucous liquid into the urethra right before ejaculation. This liquid helps the sperm move easily through the urethra and out the body.

Causes:

Male infertility results from an illness or injury that decreases the total number of sperm produced. Or, male infertility results from something that makes the sperm produced not normal, such as being unable to swim. Following are things that can cause impaired fertility in a man:

  • An illness, such as diabetes, can cause retrograde ejaculation. This is when the semen goes backward into the bladder instead of out the penis during ejaculation.
  • Infection of the sex organs, such as venereal disease (VD), prostatitis, or mumps.
  • Injury of the testicles, such as an accident, surgery, or radiation treatment for cancer.
  • Problems with the penis, such as hypospadius (hi-po-spa-d-us). This is when the urethra opens somewhere besides the end of the penis.
  • Temperature of the testicles is too high, such as having undescended testicles or living in a hot climate. Wearing tight undershorts that hold the testicles too close to the body can also keep the testicles too hot.
  • Too much smoking, alcohol, or stress. Drug abuse may also make infertility problems worse.
  • A varicocele, which is a varicose vein of the spermatic cord.

Medical Care:

  • There are often factors with both partners when infertility is found to be a problem. Ask your caregiver for information about female infertility. Finding out what may be causing you and your partner to be infertile takes time and money. This can cause emotional stress. It is very important for both partners to want to find a reason for the problem.
  • You and your partner may choose to have a fertility workup. A caregiver called a reproductive (ree-pro-duck-tiv) endocrinologist (n-doe-krih-nall-uh-jist) or "RE" will help you decide what treatments, if any, are needed. Caregivers take a health history that includes questions about past pregnancies, length of infertility, and sexual history. They also ask questions about your past and current medical history and your lifestyle. You and your partner will both have a physical checkup. You may have one or more of the following tests:
  • In vitro test of cervical mucus penetration by sperm. In vitro means a test or procedure that is done outside the body in a small glass dish. This test shows if your sperm can swim through and survive inside your partner.
  • Postcoital test of interaction between sperm and cervical mucus. This test is done 2 to 12 hours after intercourse. The test helps show if the woman's cervical mucus and the man's sperm are OK together. It can also show if there are sperm antibodies present. These antibodies see the sperm as bad so they attack and kill the sperm. Either the man's or the woman's body may make these sperm antibodies.
  • Sperm agglutination tests. This test finds out if the sperm are clumping together as a result of antibodies or infection.
  • Sperm immobilization tests. This test is done to check how well sperm swim toward the egg.

Treatment Options: There are many ways to treat infertility. Caregivers will tell you the risks and benefits of each treatment. Talk to your partner openly and make treatment decisions together.

  • Activity: Do not use hot tubs or saunas if your sperm count is low. Sperm production can be decreased if your testicles get too hot. Caregivers may also suggest that you and your partner plan intercourse every 36 hours during her fertile period. This allows more sperm to develop increasing your chance of getting your partner pregnant. Caregivers may tell you not to wait more than 7 days before having intercourse. Waiting to long can decrease the amount of sperm you have.
  • Clothing: You may be told to wear boxer shorts rather than tight underwear to keep the testicles cooler. You may also be told to bathe your testicles in cold water 2 times a day.
  • Embryo transfer: Caregivers may suggest embryo transfer if your sperm are OK and your partner's uterus is OK. Another woman is artificially inseminated with your sperm. The fertilized egg is removed from her uterus about 4 days later. The egg is then placed in your partner's uterus. This method may be used if your partner has bad scars inside her abdomen. Or, embryo transfer may be used if your partner does not have ovaries or her ovaries do not work.
  • Insemination: Insemination (in-sem-uh-nay-shun) is when sperm is collected and processed. The sperm is placed into your partner's vagina, cervical canal, or directly into her uterus. Artificial insemination or "AI" is when the sperm used comes from you. It is called therapeutic donor insemination or "TDI" when sperm is used from a sperm bank. The choice of where the sperm comes from depends upon your fertility problem.
  • Medicine may be used to treat some infertility problems, such as antibiotics or chemotherapy medicine for infections.
  • Sex therapist: Some problems may benefit from counseling with a caregiver specially trained in sexual problems, such as impotence or premature ejaculation
  • Surgery: You may need surgery to fix a varicocele (vair-ih-ko-seel). Or, you may need surgery to unblock the vas deferens or the sperm duct. Undescended testicles have to be treated with surgery during childhood.

Sometimes no cause of infertility can be found. You and your partner may choose to stop fertility treatments. Following are other options for you and your partner to consider:

  • Adoption: Adopting a baby may be the answer for couples who decide not to do infertility treatments. It may take several years to adopt a baby because more single mothers are deciding to keep their babies.
  • Foster care. Being a foster parent is when you take care of a baby or child from Social Services in your home. You may have the child for a short or long time until Social Services can find a permanent home for the child. Being a foster parent gives you a chance to see if you want to be a parent. You may be able to adopt the child if you decide that is best for you.
  • Surrogate mother. Another woman (surrogate) may be made pregnant with the semen from the infertile woman's husband by insemination. Or, an egg from the infertile woman may be fertilized in vitro with her own husband's sperm. Then the fertilized egg is put into the surrogate mother's uterus.

Dietary Measures:

  • Avoid saturated fats, hydrogenated oils, and transfatty acids in food that you eat.
  • Using cottonseed oil in cooking may put you at risk for infertility.
  • Eat at least 5 servings of fruits and vegetables a day.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Ginseng (Panax ginseng) has been used for many years, but has not been studied in men who have infertility.

Supplements:

  • Coenzyme Q10 (Co Q10) has been used, but has not been studied in men who have infertility.
  • Vitamin B 12 (cyanocobalamin) may be helpful for male infertility and has been studied in men.
  • Vitamin C may be helpful for male infertility and has been studied in men.
  • Vitamin E may be helpful for male infertility and has been studied in men.
  • Zinc may be helpful for male infertility and has been studied in men.

Complementary Therapies:

  • Acupuncture may help men with low sperm counts.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Dawson EB, Harris WA, Rankin WE et al: Effect of ascorbic acid on male infertility. Ann N Y Acad Sci 1987; 498:312-323.

2. Piesse J: Zinc and human male infertility (review). Int Clin Nutr Rev 1983; 3(2):4-6.

3. Sandler B & Faragher B: Treatment of oligospermia with vitamin B12. Infertility 1984; 7:133-138.

4. Siterman S, Eltes F, Wolfson V et al. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl 1997; 39:155-161.

5. Suleiman SA, Ali ME, Zaki ZM et al: Lipid peroxidation and human sperm motility: protective role of vitamin E. J Androl 1996; 17(5):530-537.

6. Wooley RJ: Contraception-a look forward, part II: Mifepristone and gossypol. Contraception 1991; 4:103-113.


Last Updated: 11/4/2014

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