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7400 Fannin St., Suite 1180
Houston, Texas 77054 Phone (713) 790-9900 Fax (713)-790-9901 |
Robert
B. McWilliams, MD
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Male InfertilityInfertility is defined as the failure of a couple to become pregnant after 1 year of regular, unprotected, sexual intercourse. This period of time is often shortened to 6 months when the female is over thirty-five years old. Infertility occurs in approximately 11% of couples at some time in their reproductive lives. Infertility is not "just a female problem" as there is a male infertility component in approximately 50% of couples. What causes male infertility?Low Sperm Count, Irregular Motion, Shape Most often a man is sub fertile because he produces too few (or no) sperm, the sperm might be shaped irregularly, swim erratically, or have a genetic defect. There are many medical and environmental causes of male sub fertility. Hormonal disorders of the pituitary gland, testicles, thyroid glands, or adrenal glands can cause decreased sperm count (or absent sperm). Infections of the male reproductive tract cause inflammation and can damage the vas deferens (tubes that transport the sperm). Severe mumps as an adolescent can lead to reduced sperm count as an adult. The scrotum performs a temperature regulating function for the testicles. When the temperature needs to be lowered, the scrotum expands moving the testicles farther away from the body. Conversely, when the temperature needs to be increased, the scrotum contracts pulling the testicles closer to the body. Some activities, such as constantly wearing tight jockey shorts or frequent, long, hot baths may interfere with the scrotum's temperature regulating function. Occupations, such as a long distance truck driver, where a man sits for long periods of time can also lower sperm counts. A varicocele is another common cause of poor sperm production and motility. A varicocele is a dilated vein leading to the testicles. When these veins are dilated, they cannot perform their "heating and cooling" function in conjunction with the scrotum. A varicocele that is believed to contribute to a man's infertility is often treated surgically by a urologist. Exposure to certain toxic chemicals or radiation can also interfere with sperm production and development. Additionally, it has been shown that smoking, excessive alcohol use, and "recreational" drug use can negatively affect sperm count. There are also genetic disorders that affect sperm production. Sperm DeliverySperm must be delivered into the vagina (ejaculation). Ejaculatory problems include early ejaculation, retrograde ejaculation (semen forced back into the bladder), or the inability to maintain an erection. This condition can be a side effect of some medications or can be caused by Peyronie's disease. It can also be a complication of radiation therapy or surgery. How is Male Infertility Diagnosed?All couples that are trying to conceive should have a complete infertility evaluation. In the male, this includes a semen analysis, medical history, family history, etc. In addition to a semen analysis, the physician may order blood tests to rule out sexually transmitted diseases or hormonal imbalances. How is Male Infertility Treated?The
fist step is to eliminate all negative environmental factors, such
as long hot baths, smoking, excessive drinking, recreational drug
use, etc. Other treatments might include hormonal therapy, antibiotics
for infections, or surgery to repair a varicocele. Depending on the number of sperm contained in each ejaculate, the sperm can be collected at several different times and stored as frozen sperm until there is a sufficient quantity. They are then combined, specially washed and prepared, and placed directly in the partner's uterus using a small catheter ("unwashed" or "unprepared" sperm must never be placed in the uterus as serious allergic reactions can result). In cases of severe sperm abnormalities, a sperm donor may be considered. There are several sperm banks that allow couples to pick donors (from photographs) that match the husband's physical characteristics. In vitro fertilization (IVF) is also an option. During an IVF cycle, the female receives medications to stimulate the development of multiple eggs. These eggs are retrieved transvaginally and combined with the male's sperm in a petri dish. After incubation to maturity, the resultant embryos are transferred to the mother's uterus. Other techniques, such as intracytoplasmic sperm injection (ICSI), allow men with extremely low sperm counts to father children by artificially injecting a single sperm into the cytoplasm of the egg. In the TESA procedure, a single sperm is withdrawn from the reproductive tract and inserted directly into the egg with ICSI. What can be done to help prevent male infertility?
It might
not be possible to prevent infertility resulting from genetic problems
or an illness. However, there are some precautions that can be taken:
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