Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse. It affects approximately 15-20% of all couples. Most couples generally are able to conceive during a twelve-month period without contraception. Male infertility factors account for about 50% of all cases (male cause only 30%, and male/female cause 20%). For the most part, male infertility is due to a problem with the sperm itself such as a low sperm count, poor motility (non-active or slow moving sperm), or abnormally shaped sperm. Environmental factors include overheating testicles with excessive exercise or tight underwear (holds testicles close to warm body) and toxic exposure to chemicals or radiation. Systemic diseases such as diabetes, bacterial infections, mumps, cancer and sexually transmitted diseases; side effects from certain medications; drug and alcohol abuse; smoking; trauma (surgery or injuries); psychological disorders (depression, anxiety); impotence; and intercourse problems (premature ejaculation, infrequent sexual activity) may contribute to male infertility. Finally, hormonal disorders; chromosomal (gene) abnormalities; cryptorchidism (undescended testes); immunological disorders (produce antibodies against sperm); and a varicocele (inflammation of spermatic cord veins) have also been known to cause male infertility.

Symptoms may include:

• Inability to produce a pregnancy after one year of unprotected sexual intercourse.

WHAT YOUR DOCTOR CAN DO:

• Diagnose the disease by asking about your symptoms, doing a physical exam, and ordering a semen analysis and urinalysis.
• Order laboratory tests to evaluate hormone levels and function, gene studies, sperm antibody production (body mistakenly produces immunity against sperm), or infectious conditions
• Order a post-coital test to evaluate the compatibility of sperm and cervical mucus.
• Order non-invasive tests such as a Doppler study (venous blood circulation) or ultrasound to examine testes and spermatic cord.
• Rule out other diseases or conditions such as psychological disorders or female infertility.

Treatment options:

• Review and adjustment of current medications and/or dosages
• Antibiotics for bacterial infections, steroids to correct hormonal imbalances, or hormone replacement therapy
• Surgery to remove cancer or repair abnormalities such as varicoceles, structural abnormalities or obstructions
• Artificial insemination or in vitro insemination with husband or donor sperm
• Sperm washing to limit auto-immune factors (removal of antibodies followed by some form of insemination)
• Intracytoplasmic Sperm Injection (ICSI) - Injecting a single sperm into an egg with a small pipette
• Testicular Sperm Aspiration - Biopsy (removal) of a small amount of testicular tissue with sperm cells followed by ICSI.
• Counseling or psychological assistance with sexual dysfunction, relationships, and abuse problems.

WHAT YOU CAN DO:

• See your doctor or a urologist who specializes in fertility.
• Wear loose fitting boxer shorts instead of tight, restrictive undergarments.
• Avoid hot tubs, prolonged hot showers and extended bicycle rides.
• Familiarize yourself with your partner's ovulatory cycle; have sexual relations during her most fertile period. Do not ejaculate for 3 days before these relations.
• Avoid or limit alcohol use.
• Stop smoking. Ask your doctor if you need help.
• Do not use lubricants because they tend to slow down sperm motility and some may contain spermicidal agents.
• Take all medications as directed by your doctor.
• Exercise with moderation.

WHAT YOU CAN EXPECT:

• A large percentage of male infertility cases are not serious, and for the most part treatable.
• Some complications may include psychological distress (low self-esteem, anxiety and guilt), worsening of conditions that led to infertility, and permanent infertility.

CALL 1061 OR SEEK IMMEDIATE MEDICAL ASSISTANCE If you and your partner are unable to conceive after 1 year of unprotected sexual intercourse, if you started treatment and are unable to conceive after 6 months of treatment, or if you experience side effects from the medications or treatments and if after surgery, you develop signs of infection (pus, inflammation, fever, and increased pain), or uncontrolled bleeding.