Understanding Infertility

Coital, Immunological and Surgical

There may be coital difficulties perhaps due to ejaculatory failure or impotence. Modern investigations have also revealed that a surprisingly large number of couples are affected by immunological infertility, in which the female partner rejects the male's sperm.  And finally with changes in marriage patterns, there are a growing number of men who are surgically infertile as a result of vasectomy.  Although it is possible to reverse a vasectomy, there is no guarantee that the reversal will result in a return to normal sperm functionality.

Sperm Obstruction

In up to five percent of infertile men the flow of sperm from the testicles to the penis may be blocked.  This occurs when the tubes that carry the sperm from the testicles to the prostate are obstructed or missing.  This in turn may cause a low, or no sperm count, a low semen volume, or both. Ninety-five percent of obstructions are found in the epididymis and another three percent are found in the prostate.

Lifestyle

The use of drugs such as marijuana, cocaine, tobacco, and excessive amounts of alcohol can reduce fertility.  Certain prescription drugs may also have an effect. Anything that increases the temperature around the testicles, such as frequent hot tub use, is thought to reduce fertility.  Men who use steroids for body building, ulcer medication, anti-malarial drugs or work in environments where they’re exposed to solvents found in paints and printing inks can be at greater risk.

Varicoceles

Forty percent of infertile men have vericose (enlarged) veins around the testicles known as varicoceles.  These faulty veins allow pooling of blood around the testicles resulting in damaged sperm production and sperm quality.

A doctor can often diagnose varicoceles around the testicles on physical exam by feeling the scrotum, the sac containing the testicles.  An ultrasound of the scrotum  can also be used to assess the size of the veins and to diagnose varicoceles that are not felt by the doctor.  The treatment of a vericocele to improve fertility is greatly debated and must be individualized.

Infections

Ten percent of infertile men have infections in the male reproductive tract, which affect fertility. While some of the infections are sexually transmitted many are not.

Hormonal Abnormalities

Hormones from the pituitary gland are released into the blood stream where they act on the testicles to stimulate the production of sperm and the male hormone, testosterone. Most men have normal levels of these pituitary hormones indicating that the pituitary is functioning normally.  However, two or three percent of infertile men may have abnormal hormone levels.  If the pituitary does not produce enough hormones, sperm production may not be adequately stimulated. A high level of hormones indicates that the pituitary is working well but the testicles are not responding normally. Both cases may indicate a cause for infertility.

Other hormonal problems such as diabetes, a thyroid condition, or prolactin problems (a hormone produced by the pituitary gland that stimulates lactation and the secretion of progesterone) may also cause infertility.

Sexual Practices

In two or three percent of infertile men a sexual problem such as erectile dysfunction may be identified as a cause for infertility.  In order for a pregnancy to occur naturally, semen containing healthy sperm must be deposited in the vagina.  Practices such as the use of some vaginal lubricants or improperly timed intercourse may reduce the chances of conception occurring.