Description
Fifteen to 20% of couples report infertility or no pregnancy after having unprotected sexual intercourse for several months. Since nearly 50% of infertility cases are attributable to the male partner, the evaluation and treatment of the male is extremely important. Many of the causes of male infertility are treatable and will be identified after a careful history and physical examination.
Causes
1. Varicocele, a cystic swelling around the veins leading to the testes, occurs in approximately 40% of men undergoing an infertility examination.
2. Disorders of the testes
3. Chromosomal or gene abnormalities
4. Congenital abnormalities of the male reproductive system, e.g., blockage of the tubes that carry the sperm
5. Hormone deficiency
6. Infections of the urethra, prostrate, and epididymis (usually treatable)
7. History of mumps and inflammation in both testes (orchitis)
8. Injuries to the male reproductive system, e.g., torsion (twisting) of a testis
9. Surgery to the male reproductive system, e.g., vasectomy reversal
10. Radiation injury
11. Toxins, e.g., alcohol, tobacco, insecticides, metals, drugs
12. Medications
13. Immune disorders, e.g., insulin-dependent diabetes
14. Chronic diseases, e.g., kidney failure, liver diseases, sickle cell disease
Symptoms
1. None
2. Pain in the case of torsion or infection
3. Discharge from the urethra
4. Infertility is often first indication of a problem.
Diagnosis
1. History
2. Physical examination
3. Semen analysis: the number, condition of the sperm, motility, and appearance
4. Hormonal analysis, specifically, the sex hormones such as testosterone
5. Blood and urinalysis
6. Ultrasound
7. A needle biopsy of testicles is sometimes necessary.
Treatment
Dependent on the cause may involve one or more of the following:
1. Antibiotics to treat infection
2. Surgery to correct defect, e.g., varicocele
3. Hormone replacement
4. Artificial insemination after concentrating the sperm
5. Isolation of the male's genome
Advances in the treatment of male infertility are occurring rapidly, so ask your urologist about the latest treatments.
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