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 June 15, 2003
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Male Infertility
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A couple is said to be infertile if pregnancy does not result after 1 year of normal sexual activity without contraceptives. About 25 percent of couples experience infertility at some point in their lives. The incidence of infertility increases with age. The male partner contributes to about 40 percent of cases of infertility.


Male infertility is a reasonably common problem. Being infertile has nothing to do with male sexual prowess (virility), but rather with the absence of healthy sperm in the semen that are capable of traveling to meet the ovum.


Absence of sperm or low sperm count may be due to an infection associated with high fever that occurs after puberty. Mumps has long been associated with infertility in a man. Since each sperm takes about 74 days to mature, it is important to inform the doctor of any medical illnesses or other factors that occurred in the preceding 3 months. One common problem leading to infertility is a varicocele, an enlarged varicose-type vein commonly found above a testicle in about 15 percent of all men in the U.S. A varicocele is a small flaw in the anatomy of a vein. If such a vein exists, surplus blood, and therefore too much heat, gets to the testicles, causing the sperm to die. Every man who has a varicocele is not infertile. However, about 30 percent of men who are infertile have a varicocele. The size of the varicocele seems to have no bearing on sperm count. Varicoceles can be corrected with a simple surgical procedure or a new nonsurgical technique in which a tiny silicone balloon or coil is inserted into the area to close off the swollen vein, rerouting the blood to other blood vessels. Other physical conditions that might be found include an obstruction in the duct system that could block the outflow of sperm, or an infection, which could cause scarring that could stop the sperm. When an evaluation shows that a man's testicles are producing plenty of healthy sperm but none appear in his semen, an obstruction of the tubes running from the testicles to the prostate is suspected. Microsurgical techniques for bypassing obstruction exist to remedy this situation. Sperm production may be impaired by the use of alcohol or drugs, or exposure to toxic chemicals. Hot tubs, tight bikini shorts or jeans may increase the temperature in the testes, lowering production of sperm. A woman's use of douches or lubricants can kill sperm. Sometimes a man's body reacts to its own sperm as if it were a foreign invader, producing antibodies to the sperm. The antibodies block conception by immobilizing the sperm or by preventing their passage through the woman's cervical mucus.


Quality of sperm is determined by semen analysis. After abstinence for 72 hours, the man provides the semen by masturbating into a sterile container or into a special condom during intercourse, and bringing the specimen to the doctor's office or hospital within two hours of collection. Men with low sperm counts may not have trouble fathering a child, while men with high sperm counts may. The quality of the sperm, as seen under a microscope, is the most important factor. The sperm must be moving rapidly and easily, and it must have few abnormalities. Other tests may include blood tests to evaluate for possible endocrinologic (hormonal) problems. The doctor will also conduct a physical examination to determine whether there is a condition that could affect sperm production.


Questions to ask your health care provider What is causing the infertility? What tests will you be recommending? Are the tests painful? What type of treatment options are there? If a low sperm count is detected, what type of treatment will you be recommending? How long will this treatment take? Are there any side effects?

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