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Male Infertility/Male Fertility

Where to Start

How Common is Male Infertility

Physical Causes of Male Infertility

Diseases and Conditions

Lifestyle Factors that Affect Male Fertility

Environmental Factors Affecting Male Fertility

Signs and Symptoms of Male Infertility

Diagnosis of Male Infertility

Treatment of Male Infertility

Books, Articles, and Other Information

 

Where to start:

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How Common is Male Infertility:

Approximately 10-15% of all infertility is caused solely by male infertility. In another 30-40% of couples trying to conceive unsuccessfully, male factor infertility is a contributing cause.

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Physical Causes of Male Infertility:

  • Varicocele. A varicocele is a varicose vein in the scrotum can cause reduced sperm count and motility. Often can be surgically corrected.
  • Undescended testicle. Undescended testicles are exposed to higher body temperatures and sperm production can be impaired.
  • Trauma to the Testicles
  • Prior vasectomy or vasectomy reversal
  • Erectile Dysfunction
  • Retrograde ejaculation (where semen enters the bladder rather than exits through the penis)
  • Blocked ejaculatory ducts
  • Misplaced urinary opening

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Diseases and Conditions Causing Male Infertility:

  • Cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility.
  • Anti-sperm antibodies, which can form after a vasectomy
  • Testosterone deficiency (male hypogonadism).
  • Klinefelter's Syndrome. In Klinefelter's Syndrome a man has two X chromosomes and one Y chromosome instead of one X and one Y.
  • Diabetes
  • Thyroid Disease
  • Liver Disease
  • Kidney Disease
  • Sickle Cell Anemia
  • Sexually Transmitted Diseases (STDs). STDs such as Chlamydia, gonorrhea, and genital herpes can cause scarring and block sperm passage.
  • Mumps after Puberty. Can impair sperm production.
  • Infections (e.g., prostatitis, epididymitis, orchitis)
  • High Fever
  • Down Syndrome

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Lifestyle Factors Affecting Male Fertility:

  • Emotional stress
  • Extremes of Weight. (Obesity or Extremely Underweight)
  • Alcohol. Moderate alcohol use does not affect male fertility, but excessive use reduces male fertility.
  • Recreational Drugs. For example, research has found that cocaine, marijuana, and methadone may reduce sperm count.
  • Tobacco Use. Some studies have shown that smokers have lower sperm count than non-smokers.
  • Anabolic steroids taken to bulk up muscles can cause the testicles to shrink and sperm production to decrease.
  • Saunas and Hot Tubs
  • Bicycling for long periods, especially on a hard seat or poorly adjusted bicycle.
  • Laptops Computers. There is some evidence that the heat generated from a laptop computer sitting in your lap can decrease sperm production.
  • Excessive exercise may lower sperm count.
  • Work that requires long periods of sitting with limited ability to move around.
  • Restrictive pants or underwear that cause a build up of heat around the testicles. Research has shown that it does not matter whether a man wears boxers of briefs.
  • Sexual Lubricants. Some lubricants, such as Astroglide, K-Y jelly, petroleum jelly/Vaseline, lotions, and saliva have been shown to reduce sperm movement.

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Environmental Factors Affecting Male Fertility:

  • Pesticides, Herbicides, and Insecticides. May cause reduced sperm production and testicular cancer.
  • Lead exposure may cause male infertility.
  • Mercury exposure may cause male infertility.
  • Certain medications, such as cimetidine and phenytoin. Certain medications to treat high blood pressure or arthritis.
  • Exposure to diethylstilbestrol (DES) in utero. DES was a medication given to pregnant women in the 1940s through the 1960s to prevent miscarriage. There is some evidence that sons of these woman may have fertility problems.

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Signs and Symptoms of Male Infertility:

  • The inability of the man's partner to conceive a child after one year of trying.
  • Difficulty reaching an orgasm or difficulty maintaining an erection.
  • Pain, swelling or a lump in the groin or testicles.
  • Decreased facial or body hair, enlarged breasts, or other signs of a chromosomal or hormonal abnormality.

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Diagnosis of Male Infertility:

 

Diagnosing male infertility usually involves:

  • General physical examination and medical history.
  • Semen analysis. Semen is generally obtained by masturbating and ejaculating into a special container at the doctor's office. It is however possible to collect the sample at home and bring it into the doctor's office, or to use a special condom to collect semen during intercourse. Check with your doctor about these options. Usually more than one semen sample will be requested over a period of time. Semen will be tested for:
  • Sperm Concentration (over 2 cc is normal)
  • Sperm count (over 20 million per cc or 40 million total is normal).
  • Sperm morphology (percentage of sperm that have a normal shape- it is not uncommon to have a high percent that are misshapen)
  • Sperm motility (percentage of sperm that can move forward normally- greater than 50% is normal)
  • Standard semen fluid test (thickness, color)
  • Total Volume of the Ejaculate

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Treatment of Male Infertility:

 

At least one-half of male fertility problems can be treated. Treatment methods depend on the cause. In some cases, the male partner and the female partner are both sub-fertile rather than infertile. In cases such as this, treating one partner may be enough to achieve a pregnancy.

 

Treatments for male infertility may include:

  • Timing and Frequency of Sexual Intercourse. Having sex every other day around the peak fertile time for the woman is the most effective. See our page on Ovulation tracking.
  • Surgery. A varicocele or an obstructed vas deferens can often be surgically corrected.
  • Treating infections with Antibiotics.
  • Treatments for sexual performance issues. Erectile dysfunction or premature ejaculation can often be treated.
  • Hormone treatments and medications. In cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones, your doctor may recommend treatment with hormone replacement or medications that change hormone levels.
  • Artificial Insemination Also know as intrauterine insemination (IUI). The sperm is washed and inserted with a catheter through the woman's cervix. It is inexpensive and non-invasive; therefore it is often the first step of choice. The woman may or may not be medicated with ovulatory inducing drugs.
  • In vitro fertilization (IVF) The egg is removed from the woman and put in a Petri dish with the man's sperm. The resulting embryo is then transferred after 3 to 5 days to the woman's uterus with the hope that it will implant.
  • IVF with Intracytoplasmic Sperm Injection (ICSI). Rather than let the sperm penetrate the egg in the Petri dish naturally, an embryologist manually inserts one sperm into the egg.

Alternative Medicine, Supplements, and Herbs for Male infertility
Although the evidence is limited, the Mayo Clinic has reported that the following herbs and supplements may increase male fertility.

  • Vitamin C
  • Zinc (only if you have a deficiency)
  • Selenium
  • Vitamin E
  • Vitamin B-12
  • Asian ginseng
  • L-arginine
  • L-carnitine

There is little research that has shown what quantity should be taken to increase male fertility. As always, talk to your doctor before taking any herbal remedies or supplements. Megadoses are often harmful and some supplements interact poorly with medications.

 

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Books, Article, and Other Information Related to Male Infertility:

  • Wonderful essay about male infertility from the guy's perspective-The Age of Mechanical Reproduction by Paul Ford. It is both poignant and funny and ultimately uplifting. He and his wife are now the parents of girl/boy twins.
  • Good article on Sperm Morphology by Fairfax Cryobank.
  • Great information on Male Factor in Infertility by Ferring Fertility.
  • Women's Health Resource: Male Infertility Good basic information.
  • The Urology Channel is a good starting place for researching male factor infertility.
  • If you are looking for a good summary article on the causes and treatments of Male factor infetility, you can do no better than Common causes of male factor infertility, and what can be done to help men become fathers.
  • Experiencing Infertility: An Essential Resource by by Debby Peoples Harriette Rovner Ferguson (2000) does a good job of covering the psychological affects of infertility on men, including when their is male factor infertility.
  • Overcoming Male Infertility: Understanding Its Causes and Treatments by Dr. Leslie Schover and Dr. Anthony Thomas (1999) Although this is a bit dated, the information is still mostly spot on. It was written by a clinical psychologist (Schover) and a urologist (Thomas), and their combined expertise is what makes this book shine. I especially liked the combination of research and science with personal and practical. This is one book that assumes you have a brain and a heart.
  • Center for Male Reproductive Medicine and Microsurgery at the Weill Medical College at Cornell University has an informative website that provides resources on all aspects of male infertility. The information is fairly technical, so I would suggest going to the more general sites mentioned above first, then coming to this site to learn more about a specific problem.
  • The Digital Urology Journal is a peer reviewed online journal with articles on male factor infertility. The primary audience for this journal in not the lay public, but most are easily understood by anyone with a passing knowledge of the subject. "Management of Male Infertility" is a good overview of the topic. Unfortunately, it is not dated and a look at the references leads me to believe that it is not a recent article, but the information is still relevant.
  • On March 6, 2010, Good Morning America did a story on "Men, Too: Infertility Is Not Just a Female Problem". Healthy Young Men Face Infertility and Battle Social Stigma. Check out this great article and video.
  • Was George Washington infertile? One of George Washington's greatest sorrows was the lack of a biological child. As Washington historian W.S. Randall said, "He was content with Martha, but mystified why, year after year, he and Martha could produce no Washington heir." The esteemed medical journal, Fertility and Sterility, tackles this weighty question; a little late for George, but interesting reading for anyone suffering from male infertility.
  • Hope To Be Daddy: A Guy's Infertility Voice: One man's running journal and history with infertility issues (battling male factor infertility and endometriosis).
  • Hope Restored video on embryo donation by Embryo Adoption Awareness Center.

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