Infertility

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Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year. If you and your partner are attempting to have a child or to expand your family, the difficulties encountered may be complex and can be caused by a number of factors.

Male factors often involve problems with the amount or health of sperm. Lifestyle factors play an important role in increasing your likelihood of having a baby. Small changes can make a big impact. Read more about the lifestyle changes that may improve your chances of fertility. There are also many different types of treatment that can help restore fertility, such as medications, surgery, or assisted reproductive technology (ART).

For those who are thinking about seeing a doctor for fertility tests and would like to know what to expect, see our section Tests. Our overview will help prepare you for what’s in store.

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Factors to do with male infertility often involve problems with the amount or health of sperm. This may be due to low sperm production, misshapen or immobile sperm, or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility. Causes of male infertility may include:

  • Abnormal sperm production or function: Abnormal sperm production and function can be due to various problems such as undescended testicles, genetic defects, or health problems such as diabetes. Varicocele is a condition in which the veins on a man's testicles are too large. This can increase blood flow and heat, affecting the number and shape of sperm.
  • Problems with the delivery of sperm: This may be as a result of sexual problems, such as premature ejaculation or retrograde ejaculation (when semen enters the bladder instead of emerging through the penis during orgasm). Certain genetic diseases, such as cystic fibrosis, may also cause problems with the delivery of sperm. Damage or injury to the reproductive organs can cause a blockage of the part of the testicle that contains sperm.
  • Overexposure to certain environmental factors: Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. These include pesticides, industrial chemicals and radiation. In addition, regular exposure to heat, such as in saunas or hot tubs, can elevate core body temperature, impairing sperm production.
  • Damage related to cancer and cancer treatment: Cancers can affect the male reproductive organs directly or can affect the glands that release hormones related to reproduction, such as the pituitary gland. Surgery, radiation or chemotherapy to treat cancer can impair sperm production, sometimes severely.

For information about lifestyle factors that may affect male infertility, see risk factors. 

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There are a number of lifestyle factors that can increase your risk of infertility including

  • Drug use: Taking testosterone and other anabolic steroids to build muscles can shrink testicles and halt sperm production. The use of cocaine or marijuana may also temporarily reduce the number and quality of your sperm as well.
  • Smoking: Research has shown that regular smoking impacts the sperm in a variety of ways. It decreases the size and movement of these cells and damages their DNA content. Smoking also can impact the seminal fluid, ejaculated with the sperm.
  • Excess alcohol: Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production.
  • Emotional stress: Stress can interfere with certain hormones needed to produce sperm, and when stress is prolonged, can affect your sperm count.
  • Obesity: Obesity can thwart a man's fertility in many ways. It can lower libido, reduce sperm count and disrupt hormone balance. Maintaining a healthy weight and diet can significantly increase a man's chance of conceiving.
  • Occupation: Some pesticides, heavy metals and industrial agents reduce sperm production. A job that involves extended contact with such chemicals can affect male fertility.
  • Prolonged bicycling: Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. In some cases, bicycle seat pressure on the area behind the testicles (perineum) can cause numbness in the penis and erectile dysfunction.
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During the first visit, your doctor will most likely ask for both partners' health and sexual histories. This will include details about the medications you are taking, illnesses you’ve had and information about your sexual habits. He or she will typically conduct a general physical exam. For men, this will include an examination of your genitals.

Specific fertility tests for men may include:

  • Semen analysis: Your doctor may ask for one or more semen specimens to analyse the health of the sperm and the semen fluid. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container.
  • Hormone testing: Another common test for men is hormone testing via a blood test. This can determine the level of testosterone and other male hormones that play a part in fertility.
  • Ultrasound: An ultrasound may be done to find problems in the ducts and tubes that the semen moves through, and to look for evidence of conditions such as retrograde ejaculation. Ultrasound may also be used to find problems in the scrotum that may be causing infertility.
  • Genetic testing: Genetic testing may be done to determine whether there's a genetic defect affecting fertility.
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Treatment of infertility will take into account the cause, how long you've been trying to get pregnant, as well as your age and your partner's age. Infertility treatment can involve a significant commitment financially, physically and psychologically.

Treatment for men is usually centered on general sexual problems or lack of healthy sperm. It may include:

  • Medication or behavioral approaches: Medications or behavioral therapy may be used to address cases of impotence or premature ejaculation.
  • Surgery: Surgery can help treat male infertility. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired.
  • Treating infections: Antibiotic treatment may be used to cure an infection of the reproductive tract, which can help restore fertility.
  • Hormone treatments and medications: Your doctor may recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
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