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Male Infertility

What is infertility?

Infertility is the inability to get pregnant after trying for at least 1 year without using birth control. About 15% of couples are infertile.

How often are male factors involved?

About one-third of cases of infertility are caused by male factors alone. A combination of male and female factors causes about one-third of cases.

What causes male infertility?

The most common cause of male infertility is a varicocele (say: "var-ee-koh-seal"). This is when the veins in the scrotum (the skin "sack" that hangs beneath the penis) are dilated (enlarged) on 1 or both sides. This heats the inside of the scrotum and may affect sperm production. A blockage in a man's reproductive system may cause male infertility. Some medicines can also cause infertility.

Sometimes the cause of male infertility cannot be identified. In these cases, there may be an underlying genetic problem.

When should I see a doctor?

Usually, a couple should wait to see a doctor until after they've tried to get pregnant for a year. However, it's OK to see a doctor sooner, especially if the woman's age may be a factor.

Should men be checked for infertility?

Yes. It's important to identify and treat any correctable problems. In some men, a doctor's exam may find an underlying medical problem that is causing the infertility.

How is infertility evaluated?

Your doctor will obtain your medical history, examine you and test your semen at least twice. A semen analysis can tell your doctor about your sperm count and sperm quality. These are important parts of fertility. More testing may be needed, depending on the results of this first evaluation.

Is male infertility treatable?

More than one-half of cases of male infertility can be corrected. Treatment may help a couple get pregnant through normal sexual intercourse. Even if you can't get pregnant in this way, you may not need expensive or invasive treatments to get pregnant. If the man needs surgery to correct the problem that is causing his infertility, it can be an outpatient procedure. This means he doesn't have to stay in the hospital overnight.

Female Infertility

What is infertility?

Infertility is the failure to become pregnant after 1 year of regular, unprotected sexual intercourse. Infertility is a problem for 1 of every 6 couples.

How does it occur?

Often the reason a woman is infertile is that she is not ovulating (releasing eggs). This failure to ovulate may be caused by:
• a hormone imbalance
• overweight
• too much stress
• ovary problems, such as a tumor or cyst
• a menstrual cycle that is too brief
• weight loss for various reasons, including eating disorders such as anorexia and bulimia
• intense exercise, such as long distance running, that causes loss of body fat
• abuse of alcohol or drugs
• thyroid or adrenal gland problems
• tumors in the pituitary gland
• medical illness such as diabetes.

A damaged fallopian tube or uterus can also cause infertility. These organs may be damaged from:
• an infection, such as a sexually transmitted disease or pelvic inflammatory disease
• a birth defect
• polyps in the uterus
• surgery to remove a tubal pregnancy
• endometriosis (tissue from the uterus growing outside the uterus)
• fibroids (a type of growth in the uterus that is usually not cancerous)
• a uterus with an abnormal shape or position
• adhesions (scar tissue) inside the uterus or in the pelvis
• DES syndrome, which you may have if your mother took the medication DES to prevent a miscarriage when she was pregnant with you
• chronic medical illness.

You may have problems with your cervix, such as:
• cervical stenosis (a cervix that is very narrow or closed)
• abnormal cervical mucus.

In rare cases, a woman's body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility.

You also become less fertile as you get older, especially after age 30.

How is the problem diagnosed?

You and your partner will have thorough physical exams. You will be asked about:
• your sexual history, including previous pregnancy, miscarriage, or abortion
• your history of medical conditions such as illnesses and infections
• your family history
• use of drugs and alcohol
• sexual intercourse practices, such as how often you have sex and whether you use lubricants
• genital or abdominal surgery
• circumcision
• genital development.

Tests that may be done are:
• urine and blood tests to check for infections and a hormone imbalance
• tests of samples of cervical mucus and tissue from the lining of your uterus to check for ovulation
• a count of your partner's sperm to see if the cause of infertility is too few sperm or abnormal sperm
• ultrasound scans.

Your health care provider may tell you how to take and chart your body temperature each morning. A woman's temperature rises after ovulation. The chart helps check for ovulation.

You may have the following procedures to check for a blockage in the fallopian tubes or uterus or for adhesions:
• laparoscopy (a scope is inserted into your abdomen so your provider may see the organs)
• injection of a blue-colored fluid through the cervix and uterus and into the fallopian tubes to help your provider see possible blockages with a laparoscope
• hysterosalpingogram (an x-ray of the uterus and fallopian tubes after they are injected with dye).

How is it treated?

If you have a disorder causing infertility, your health care provider will recommend treatment for it. Treatment may include medicine, such as hormones or antibiotics, or surgery. Sometimes a combination of treatments for both partners is necessary.

Possible treatments include:
• Taking hormones for a hormone imbalance, endometriosis, or short menstrual cycle.
• Taking drugs to stimulate ovulation. (You may become pregnant with more than 1 baby if your ovaries are overstimulated by hormone treatment.)
• Having surgery to remove blockage or scar tissue from the fallopian tubes, uterus, or pelvis.
• Having surgery to remove polyps or fibroids from the uterus.

You may be asked to keep a record of your daily temperature to track ovulation. This will help predict when you are most fertile or if the drugs you are taking stimulate egg production.
If your partner's sperm count is low, artificial insemination is an option. The sperm is collected at several different times and then placed in your body during the most fertile time in your menstrual cycle. This procedure has varying success. Another choice is to use sperm donated by another man.

In vitro fertilization is another option. In this procedure eggs are removed from your body and fertilized with sperm in the lab. The fertilized eggs are then put into your uterus or fallopian tubes. This procedure may be done if your partner's sperm count is low or your fallopian tubes are blocked or damaged. In vitro fertilization is expensive and success rates are often low. You may become pregnant with more than 1 baby at a time.

The period of investigation and treatment for infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through any difficult times.

What can be done to help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or an illness. However, you can do the following to reduce the risk of infertility :
• Prevent sexually transmitted diseases by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Limit the amount of alcohol you drink.
• Avoid the use of street drugs (such as heroin) and overuse of prescription and nonprescription drugs.
• Maintain good personal hygiene and health practices.
• Do not use lubricant during sexual intercourse because it can make it harder for the sperm to reach the egg.

Contact your health care provider about any signs of infection or hormonal change, such as:
• unusual discharge from the vagina
• abdominal pain
• fever
• abnormal bleeding
• a change in your menstrual periods
• discomfort during intercourse
• sores and itching in the vagina or rectal area.