An Introduction to Male Infertility

Men prefer to see things in the simplest possible terms. Car go fast. Watch game now. Meat good.

It’s little surprise that when the complicated and sensitive issue of infertility arises, we men shrug our shoulders and assume the problem exists somewhere in the House of Mystery that is a woman’s body. After all, thinks the guy, I just have this three-piece set here. It seems to be working. Must be you.

This male-centric thinking pre-empted a closer look at men’s infertility for centuries. But today, half of all couples who seek help conceiving find some contributing male factor, and about a third learn there is no issue with the woman’s fertility at all.

Any couple who has been having regular, unprotected sex for a year or more without pregnancy is considered “subfertile” and should investigate possible male causes. A trip to the urologist and a few lab tests can save time and heartache—not to mention thousands of dollars in more advanced solutions.

Fertility specialists begin by taking a medical history, physical examination and semen analysis.

Medical history
Urologists will ask detailed questions of your medical background because several diseases, conditions and surgeries adversely affect male fertility. Leading the category are surgeries involving reproductive organs (such as procedures for hernias or undescended testicles) and histories of disease (especially sexually transmitted diseases). Cancer patients may be infertile as a result of chemotherapy or radiation treatment.

Lifestyle choices are also a big factor. Primary vices to control include alcohol, tobacco, steroids and marijuana. Heavy drinkers and serious pot smokers have lower testosterone levels and increased instances of abnormally shaped sperm (see “morphology” on the next page). That doesn’t mean their children will be abnormal, but their ability to conceive may be compromised.

If you frequently take hot baths, steams or saunas, back off for a while, since heat decreases the ability to make sperm. Similarly, tight pants can impair healthy blood flow and make it too warm downstairs.

Ten percent of all infertility is due to sexual dysfunction. If that’s an issue, just tell your doctor and ask for help. You can’t get on base if you can’t swing the bat.

Physical examination
The urologist will want to do an equipment check for cysts, small testes and signs of blockage in reproductive ducts. He will also examine you for the most common cause of male infertility: varicocele (var-i-ko-seel’).

Dr. Marc Goldstein of the New York Weill Cornell Medical Center is among the world’s top specialists in male infertility. “Varicoceles are varicose veins of the scrotum,” he explains. “Fifteen percent of all men have varicoceles, and 40 percent of all infertile men have them. But treatment has improved dramatically.”

Like the hot tub, dilated veins impair sperm production by raising the temperature of the testicles. Varicocele is easily diagnosed by having the patient cough or strain so that the doctor can detect bulging veins. Dr. Goldstein introduced an effective and remarkably successful treatment called microsurgical varicocelectomy more than 20 years ago.

“Treatment using the current microsurgical technique is an outpatient, minimally invasive procedure that involves making a small cut of about two centimeters in the low groin. I’ve done 3,200 of these operations, and only 23 of them have failed—meaning the varicocele did not go away or it came back.”

If a varicocele correction is recommended, do your research and consult a trusted physician.

Semen analysis
It may be humbling to hand a cupful of love to a nurse, but providing semen for analysis is noninvasive and yields valuable information about your potency. It’s a wise first step for any subfertile couple to take. A sample can be produced in the doctor’s office or at home, provided you can get to the lab quickly.

A basic semen work-up analyzes four factors:

• Semen volume—amount of fluid produced
• Sperm count—number of sperm per milliliter of semen
• Motility—how well your boys can swim
• Morphology—shape of sperm’s head, neck and tail

It’s common for urologists to order a follow-up semen analysis. Your doctor may also send you for hormone analysis or test for anti-sperm antibodies. Antibodies result when the immune system sees sperm as a foreign body, like a disease, and attacks it.

By the time you complete your own research and testing, you may believe men are as complicated as women. But couples today can find comfort in the fact that there are nearly as many solutions as there are variables. Lifestyle changes alone can increase sperm count and quality, and simple medical procedures can get you back on track. Blockages can be cleared, hormones can be supplemented, , a single sperm can be removed from the testes and implanted in an egg. As Dr. Goldstein jokes, “It’s a fertile field for research.”

Some terms to know

• Aspermia: No fluid is ejaculated at orgasm.
• Azoospermia: The complete absence of sperm in semen.
• Blood-testis barrier: The lining that separates reproductive ducts from the bloodstream. A compromised barrier, which can result from varicocele, often results in antibodies.
• Spermiogenesis: The sperm’s development from spermatid to spermatozoa stage.
• Undescended testicle: “Cryptorchid testes” is the medical term for testes that do not descend normally into the scrotum before birth. The condition results in infertility for 50 percent (one undescended teste) to 90 percent (both undescended) of afflicted males.
• Varicocele: A correctible condition in which varicose veins make the testicles too warm for healthy sperm production.

Dr. Marc Goldstein, FACS
Professor of Reproductive Medicine and Urology and Surgeon in Chief
Department of Male Reproductive Medicine and Surgery, New York Weill Cornell Medical Center
See www.maleinfertility.org

Male Factor: Clinical Evaluation of the Semen Analysis
By Drs. Patricia E. Barg and Harry Fisch
Fertility and Hormone Center of the Montefiore Medical Center
Dobbs Ferry, N.Y.

The American Fertility Association
www.theafa.org

The American Urological Association Inc.

The New England Journal of Medicine

Contemporary Urology

Source: MSN Health & Fitness