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Male Infertility Evaluation: What You Need To Know

 

What is the definition of infertility?

Infertility is the inability to impregnate or achieve pregnancy after one full year of unprotected sex.

How often do male factors cause infertility?

Male factors cause infertility in 20 to 30% of couples and contribute to infertility in another 20 to 30% of couples. Generally, around one half of infertile couples are the result of male factors.

How is male infertility evaluated?

The primary male infertility evaluation begins with a medical and reproductive history and 2 semen analyses (sperm counts). In case abnormalities are found in the primary evaluation, the man needs to consult a male reproductive specialist for a complete history and physical examination. Further testing may be necessary at times.

What male factors can cause infertility?

Here are some of the common problems known for causing infertility include:

Varicocele

A varicocele refers to an abnormal dilation of veins in the scrotum and is detected on physical exam. It happens more commonly on the left but can also occur on both sides. Besides infertility, a varicocele can lead to discomfort. In general, a varicocele has to be corrected in infertile men, in those with abnormal semen analysis whereas their partners have little or no infertility issue.

Most men who have varicocele are not infertile and have no varicocele-related issues.

Obstruction

Another common reason for male infertility is obstruction, or a reproductive tract blockage. The most common cause is vasectomy, but other causes of blockage include trauma or infection.

Medications

Medications can lead to infertility as well. In certain cases, stopping the medication is enough to allow a man to impregnate his partner. Common medications that result in infertility include testosterone and chemotherapy (for cancer). They both suppress sperm production. In most men, stopping testosterone allows the return of sperm production to the same level as before taking the medicine.

Based on the amount and type of chemotherapy, certain men will recover sperm production with time. Since many men will not recover sperm production, it is important for men to freeze their sperm before going for chemotherapy.

Other causes of male infertility include:
  • Hormone abnormalities
  • Ejaculation problems

These are less common problems that can be treatable. Men that have hormonal problems need specialized testing to find out any serious underlying problem, for example, a pituitary (brain gland) disorder.

Some men will have genetic problems that cause infertility and are treatable. Men with genetic problems need counseling about the way problems may affect them or their coming off-springs.  In a significant number of men, there is no way to identify the cause of infertility.

In what ways can these male infertility problems be treated or corrected?

It depends on the causes. To correct varicocele, surgical or other procedures are required. As many as 40% of men can impregnate their partner after varicocele correction. This depends on the degree of improvement in sperm count and movement (motility) and on female factors that contribute to infertility.

In a lot of instances, surgery can be performed to reverse a vasectomy. The chance a vasectomy reversal success depends on the duration the vasectomy has been since it was performed and also the surgical technique used, and female factors, for example, the age of the female partner.

Hormonal problems as well as some ejaculation issues can be treated using medications, depending on the particular cause.

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