What is infertility?

Infertility is the failure of a couple to become pregnant after 1 year of having regular, unprotected sexual intercourse. Problems in the male reproductive system can prevent a woman from getting pregnant.

Infertility is a problem for one of every six couples. Problems in the male partner are responsible for about 50% of infertility cases. Many couples seek help from a specialist.

How does it occur?

Male infertility most commonly occurs because the man produces too few sperm or no sperm at all. Reasons for this include:

• exposure to toxic chemicals or radiation

• a genetic disorder, such as Klinefelter's syndrome

• taking frequent, long, hot tub baths

• alcohol, tobacco, or drug abuse

• a severe mumps infection as an adolescent or adult.

Sometimes the sperm are abnormal. That is, they are malformed and cannot swim properly or they have a short lifespan. A normal sperm has a lifespan of about 4 days. Defective sperm can result from:

• inflammation of the testicles (a possible complication of having the mumps as an adult)

• hormone-related problems (such as certain tumors of the pituitary gland)

• damage to the spermatic tubes (resulting from a previous vasectomy or a bacterial infection such as gonorrhea or chlamydia)

• abnormally twisted or swollen veins in the scrotum (the sac that holds the testicles)

• abnormally developed testicles (most often of unknown cause, but in rare cases caused by a hormone-related problem).

Sometimes the problem is in delivering the sperm to the woman's vagina (ejaculation). Problems with ejaculation may include:

• early ejaculation

• retrograde ejaculation (semen is forced back into the bladder)

• inability to maintain an erection (possibly due to side effects of some blood pressure medications or diseases such as diabetes or Peyronie's disease)

• a complication of radiation therapy or surgery.

Sometimes the problem is a natural decline in fertility that comes with aging. The decline occurs more rapidly after age 40.

How is it diagnosed?

A couple's failure to become pregnant can be due to male or female problems, or both. At first, the couple usually sees a primary care physician together.

Specialists are often consulted to investigate and treat infertility. Men usually see a urologist. The doctor will give you a physical exam.

You may have to give the doctor more information to help determine why pregnancy doesn't occur. The doctor will ask both you and your partner questions during joint and separate interviews. Knowing if the man or woman has had children with another partner will help the doctor make a diagnosis.

Some of the questions usually asked are about previous medical conditions such as illnesses and infections, use of drugs and alcohol, sexual intercourse practices, detailed sexual history, genital surgery, circumcision, and normal genital development.

The doctor may order the following tests:

• a semen analysis to check for the number and quality of sperm

• blood tests to check for infections from sexually transmitted diseases and for a hormone imbalance

• cultures of fluid from the penis to check for infections.

How is it treated?

If the doctor discovers an underlying disorder that is causing the infertility, he or she will recommend treating this problem to try to restore fertility. Treatment may include medication (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments for both partners is necessary.

To restore your fertility the doctor may suggest that you do the following:

• Take hormones to treat a hormone imbalance.

• Take drugs to stimulate sperm production.

• Take an antibiotic to clear up an infection.

• Avoid long, hot showers and frequent use of hot tubs and saunas. High temperatures can reduce your sperm count. Also, wear boxer shorts rather than jockey shorts.

• Have therapy to treat ejaculation problems.

• Have surgery to correct a disorder in the testicles.

If you cannot produce any sperm, you must consider other choices, such as a using sperm donated by someone else or adoption.

If your sperm count is low, artificial insemination may be an option. The sperm is collected at several different times, stored until there is a sufficient amount, and then placed in the woman's body during the most fertile time in her menstrual cycle. This procedure has varying success. If your sperm count is still too low or the sperm are not able to function properly, the woman could become pregnant using sperm donated by another man.

In vitro fertilization is yet another option. In this procedure, the egg is fertilized with sperm in the laboratory and implanted into the woman's body. This procedure is an option if the man's sperm count is low or the woman's fallopian tubes are blocked or damaged and cannot be corrected with surgery. In vitro fertilization is expensive and success rates are often low.

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

What can be done to help prevent infertility?

You may not be able to prevent infertility resulting from genetic abnormalities or an illness.

Some of the things you can do to reduce your risk of developing disorders that might cause infertility include:

• Prevent sexually transmitted diseases by using condoms and making sure that both you and your partner only have sex with each other.

• Limit the amount of alcohol you drink.

• Avoid use of recreational drugs (such as marijuana) and overuse of prescription and over-the-counter drugs.

• Avoid exposure to toxic substances such as industrial chemicals, herbicides, and pesticides.

• Maintain good personal hygiene and health practices.