Male Factor Subfertility And Infertility

GENERAL INFORMATION:

What is male factor subfertility and infertility?

• Male factor subfertility and infertility are conditions where a man is having problems getting a woman pregnant. Subfertility is where a man has been unable to get a woman pregnant after one year of unprotected regular sex. This means not using any birth control methods, such as birth control pills, diaphragms, condoms, or the rhythm method, and having sex often. Male factor infertility is being unable to get a woman pregnant from a sperm problem in the man. These problems include asthenozoospermia (poor sperm movement), oligozoospermia (low number of sperm), and teratozoospermia (abnormal sperm shape).
  
  
• The male reproductive system includes the testicles, prostate, penis, scrotum, vas deferens, epididymis, and seminal ducts. Each testicle inside the scrotum produces sperm. The sperm are found in the man's semen. The semen is the white fluid that the man ejaculates (pushes out of his penis) during sex. After ejaculation inside the vagina, the sperm looks for the woman's egg. A sperm's tail moves with whip-like movements back and forth. This lets it travel towards the egg. The sperm must reach the uterus and the fallopian tube to fertilize a woman's egg. When this occurs, pregnancy happens and a baby will be created. Problems with the movement, shape, or number of sperm may affect male fertility. With treatment, such as medicine and surgery, you may become fertile and your partner may get pregnant.

What causes male factor subfertility and infertility? The cause of male factor infertility may not be known in some cases. In other cases, a man may become infertile because of problems with his reproductive system. The following are possible causes:

• Medicine: Steroids and medicines to treat high blood pressure, cancer, or depression, may affect male fertility.
  
  
• Genetic: You may have been born with genes that cause infertility. A gene is a piece of DNA that tells your body what to do or what to make. The genes may affect how sperm are made (sperm production), how they move, and how well they can travel.
  
  
• Immunologic: An immune system problem may cause antibodies to be produced that attack your sperm. The immune system is your body's defense system against infections and diseases.
  
  
• Infections: Chronic (long-term) infections in the male reproductive system may affect male fertility.
  
  
• Low hormone levels: Hormone disorders in the testicles, or tumors in the pituitary gland, may cause subfertility.
  
  
• Sperm duct blockage: The seminal ducts are tubes that carry sperm from the testicles to another part of the body, such as the urethra. When these tubes are blocked, there may be no sperm in your semen.
  
  
• Few and abnormal sperm: A combination of a low sperm count, and sperm with poor movement and abnormal shape may decrease your fertility. Ask your caregiver for information about this condition (oligoasthenoteratozoospermia).
  
  
• Varicocele: In some men, the veins (blood vessels) in the scrotum are enlarged and dilated (widened). This is called a varicocele. Ask your caregiver for information about this condition.

What are the signs and symptoms of male factor subfertility and infertility? You may have any of the following:

• Not able to get your partner pregnant.
  
  
• Presence of a mass or swelling on the scrotum that feels like a bag of worms (varicocele).
  
  
• Stress or emotional pressure from not being able to make a baby.

How is male factor subfertility and infertility diagnosed? Your caregiver will ask you about your current health and your health in the past. He may need to know how long you and your partner have been trying to get pregnant. Tell him when and how often you have sex, and if you have problems with sexual urges and functions. You will also be asked about your lifestyle, including if you drink alcohol or smoke, and what medicines you use. You may need any of the following:

• Physical exam: Your caregiver will look for signs of low hormone levels (hypogonadism), such as increased body hair and breast tissue. Hypogonadism is a problem with the functioning of the testicles. Your caregiver will also check the size and shape of your testicles and will look for varicoceles.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Genetic screening: Genetic testing may be done to look for abnormal genes. Abnormal genes may cause you to produce no sperm or a low number of sperm.
  
  
• Semen analysis: A semen analysis is a test to check a man's fertility. A high number of white blood cells in the semen may cause problems with sperm movement and function. You will need to ejaculate semen for this test. Talk with your caregiver about how this will be done.
  
  
• Sperm analysis: The movement of sperm and how fast they travel through mucus may be tested. The number of sperm may also be counted.
  
  
• Spermatic venography: This test looks at the position of the veins in the scrotum. During this test, your caregiver will put dye into your body and take x-rays to look for a varicocele. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye.
  
  
• Ultrasound: A scrotal ultrasound uses sound waves to find lumps and other changes in your testicles and scrotum.
  
  
• Urinalysis: Post-ejaculatory urinalysis is a test that is done on your urine after you have ejaculated. This test looks for sperm in the urine, which may suggest a blockage or problems with your ejaculation.

How is male factor subfertility and fertility treated? The treatment will depend on the cause of your infertility. You may have any of the following:

• Medicine: Antibiotics may be given to treat an infection of the reproductive system. Hormones, such as testosterone, may be used to treat low hormone levels. Steroids may be used to treat infertility from an immune system problem.
  
  
• Percutaneous embolization: This procedure may be used to treat a varicocele. The blood flow in the enlarged veins is blocked off. This stops the flow of blood and treats a varicocele.
  
  
• Sperm extraction: Sperm may be removed from the testicles or epididymis if a blockage is present. The collected sperm may be saved or used to fertilize a woman's egg.
  
  
• Surgery: Surgery may need to be done, such as removing a varicocele or pituitary tumor. Ask your caregiver for more information if you need surgery.

Where can I find more information? Having male factor infertility may be hard for you. You and those close to you may feel angry, sad, or scared. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. Contact any of the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Society for Reproductive Medicine
  1209 Montgomery Highway
  Birmingham, AL 35216-2809
  Phone: 1-205-978-5000
  Web Address: http://www.asrm.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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