What is infertility?
Infertility is a medical condition in which a couple is unable to conceive a baby. Experts don't consider a couple to have fertility problems until they've been actively trying to get pregnant for at least one year, or if the woman is older than 35, for more than six months. Some couples who experience recurrent miscarriages may also be considered infertile and should seek help from their doctor or a fertility expert.
Experiencing infertility, though, doesn't mean you won't ever have a baby. For some couples, it just takes longer; for others, it may require drugs, surgery or high-tech help. Take heart in the following stats from the Mayo Clinic:
- After 12 months of unprotected sex, about 85 percent of couples will get pregnant.
- Of the remaining 15 percent, about half will get pregnant over the next three years, using methods like medications, surgery, assisted reproductive technology, or even naturally.
According to other research, about two-thirds of all couples who seek treatment for fertility problems are able to have a baby eventually.
Are men or women more likely to experience infertility?
It's pretty much an even split, despite persistent misconceptions that infertility is a "woman's problem." About one-third of cases are due to women's health issues, another third are due to men's health issues, and the rest of the time, it's either a mix of both partners' conditions or unknown causes.
What causes infertility in men?
Making a baby is a complex process that's contingent upon four crucial steps:
- A woman and man each producing eggs and sperm
- Healthy fallopian tubes that allow the sperm to easily get to the egg
- Sperm's ability to fertilize the egg upon reaching it
- A fertilized egg's ability to attach to the uterus and continue developing normally
Infertility may result when there's a hiccup in one or more of these steps. Most infertility problems in men result from difficulty producing healthy sperm or from a glitch in the sperm's ability to reach and fertilize an egg.
Problems producing sperm: It takes just one sperm to fertilize one egg to make a baby, but the chances of any given sperm cell reaching and penetrating an egg are very slim. The more sperm released after ejaculation (a measure known as sperm count), the better your odds for conceiving. Men who have sperm counts of 10 million or less sperm per milliliter of semen may have more fertility problems than those with normal sperm counts (20 million or more sperm per milliliter of semen).
To make the long trek from your vagina all the way to the egg in your fallopian tube, sperm also need to be in tip-top shape -- those that are abnormally structured may not be able to go the distance or penetrate the egg once they do arrive.
Sperm production and quality problems may be due to a number of factors, including imbalances with testosterone or other hormones; abnormalities with the testicles; including a varicocele (a varicose vein in the testicle that may keep the temperature too warm to produce sperm normally); exposure to certain environmental toxins or chemicals; taking certain medications (like steroids); genetic conditions; certain infections, like sexually transmitted diseases chlamydia and gonorrhea; and cancer and its treatments like chemotherapy and radiation.
Problems with releasing sperm: Sounds obvious, but sperm need to be able to leave the penis in the first place in order to reach the egg -- and some male fertility problems result from issues or blockages that prevent that. These include sexual problems, like premature ejaculation or trouble maintaining an erection; retrograde ejaculation, where semen backflow into the bladder instead of out through the penis; and blockages in the testicles or tubes that carry sperm.
Men who've previously had a vasectomy -- a procedure that makes men sterile (as a form of birth control) by cutting the tubes that deliver sperm from the testicles to the penis -- also fall into this group. In one study of men seeking help for infertility, more than 50 percent were looking to reverse a vasectomy compared to only five percent of men who sought to reverse vasectomies 30 years ago.
Certain diseases or conditions make some of these factors more likely. For example, diabetes or problems with the bladder or prostate may affect retrograde ejaculation; men with cystic fibrosis often have problems with the vas deferens, the tube that transports sperm from the testicles to the penis.
What may increase a man's risk of infertility?
Many of the same issues that affect a woman's risk of infertility also affect her partner's:
- Smoking cigarettes. Research shows that cigarettes and tobacco reduce male fertility, likely by reducing semen quality. One recent study found that couples who smoked were more than three times as likely to take more than six months to get pregnant compared to couples who didn't smoke.
- Excess alcohol and drugs. Moderate drinking is unlikely to impact fertility, but consuming levels that may harm the liver or other organs can make men less fertile by lowering testosterone, shrinking the testicles, causing difficulty getting an erection, and slowing sperm mobility. Certain drugs -- especially steroids used by athletes and bodybuilders -- may affect sperm quality as well. Using cocaine or marijuana may decrease sperm quality and quantity by as much as 50 percent.
- Obesity. Being significantly overweight can throw off hormones that affect male fertility. One study found that a 20-pound weight gain can increase infertility in men by 10 percent.
- Sexually transmitted diseases. STDs like chlamydia and gonorrhea (both easily treatable with antibiotics) may lead to damage in the testicles that cause scarring, blocking sperm.
- Age. Though significantly less of a factor than with women (just look at David Letterman, Paul McCartney, and Jack Nicholson, who all fathered children after they were well into their 50s), age does affect sperm quality. And some research has linked paternal age to conditions like autism in their children.
- Excess stress. As with women, major life stresses -- like a death in the family, job loss, etc. -- may affect fertility by causing hormonal swings that affect sperm count and libido.
Does wearing tight underwear or using hot tubs impact fertility in men?
Because extremely warm temperatures can decrease sperm count, it's been speculated that wearing briefs instead of boxers, using hot tubs, or even keeping a laptop computer on your lap too long can decrease fertility, though there's not a lot of good evidence of this, says Christopher Williams, MD, a reproductive endocrinologist in private practice in Charlottesville, Virginia and author of The Fastest Way to Get Pregnant Naturally.
"Study results are mixed at best, and if there is any effect, it's likely just temporary," he says. Certainly, there's no harm in your guy sticking to boxers or avoiding hot tubs while you try to conceive, but don't expect it to speed up your pregnancy timeline significantly either.
When should men see a doctor for infertility?
Men and women are often evaluated for fertility problems at the same time, so generally speaking, the same guidelines apply here too:
- Where the woman is under 35, couples who've been unsuccessfully trying to get pregnant for more than one year.
- Where the woman is over 35, couples who've been unsuccessfully trying to get pregnant for more than 6 months.
- While fertility problems in men don't often have symptoms, those with sexual problems or health conditions or risk factors known to impact fertility may want to get checked out sooner.
Do men need to see a fertility specialist?
Testing for fertility issues in men usually starts with a semen analysis, which can be done by most family doctors or internists. If that turns out normal, additional testing might be required. Your partner's doctor may then recommend him to see a urologist (a doctor that specializes in male reproductive health) or a fertility specialist.
A fertility specialist -- officially called a reproductive endocrinologist or RE -- is an ob-gyn who has had an extra three years of training (on top of four years of regular ob-gyn education). After completing these seven years of training, doctors take a series of written and oral tests to become board certified in reproductive endocrinology.
If you know that you or your partner have health conditions that may affect fertility or are older than 35, you may want to bypass your own doctors and head straight to an RE, who can help to diagnose and treat both men and women.
How do I find a fertility specialist?
Start by asking your current ob-gyn or family physician, friends, or family members for a referral. Organizations like the Society for Reproductive Endocrinology and Infertility and the American Society for Reproductive Medicine have great Web sites with listings of specialists.
During your first phone call or visit, ask the doctor or office staff about costs, insurance coverage, and payment plans; the types of tests he or she will use; office hours, availability to patients, and willingness to talk with you at length about your situation. Infertility testing and treatment require a big commitment from you and your doctor, and you'll want to make sure you've chosen someone you're comfortable with and trust with big emotional and financial decisions.
A word of caution: Be careful not to choose a specialist based on statistics alone. Of course high success rates are important, but some clinics may have higher ratings than others because they're more selective about the patients they take on. And obviously, larger clinics with more doctors and patients will result in more babies than smaller practices will produce.
The Centers for Disease Control and Prevention publishes a national report on fertility clinic success rates, which you may want to check out as part of your research.
How will a doctor test for infertility in men?
Fertility testing in men usually starts with a semen analysis and a general physical exam; if those turn out normal, then other tests may be needed. Here's a brief overview of the types of tests or procedures men may experience:
- General physical exam: This includes an examination of medical and sexual history, including medications, previous health conditions and surgeries.
- Semen analysis: Your partner will deposit a sample of semen at the doctor's office (usually after not ejaculating for two to three days), which will be analyzed for sperm quantity and quality. Since semen sample quality can vary greatly from one day to the next, sometimes more than one sample may be needed.
- Hormone testing: Blood tests may reveal imbalances in testosterone or other hormones needed to produce healthy sperm.
- Transrectal and scrotal ultrasound: These can help a doctor diagnose conditions like retrograde ejaculation (where semen backflow into the bladder instead of out into the vagina) or blockages in the testicles or tubes that carry sperm.
What are different treatment options for infertility in men?
How men are treated for infertility depends on their test results and the problems they turn up. According to the American Society for Reproductive Medicine, up to 90 percent of infertility cases are treated with drugs or surgery -- not assisted reproductive technologies like IVF. As a general overview, men are typically treated for infertility in one of the following ways, or sometimes, through a combination of several:
- Surgery: Different procedures may fix blocked or scarred tubes, remove varicoceles, which are varicose veins in the testicles that can hinder fertility, or reverse vasectomies.
- Intrauterine insemination: AKA artificial insemination, sperm are directly inserted into the uterus using a syringe -- bypassing the intercourse part of babymaking. This treatment is used most often for men with low sperm counts or other issues with sperm quality or quantity.
- Assisted reproductive technology: This includes several methods (IVF is the main one) where eggs are fertilized with sperm in a lab and then put back into the woman's body to develop into a fetus. ART increases your risk of getting pregnant with multiples. A specific type of ART, called intracytoplasmic sperm injection (ICSI) may be needed when the man's sperm count is very low or the sperm have motility problems. In this procedure, sperm is directly injected into an individual egg.
- Fertility drugs: The same hormone combinations used to treat ovulation problems in women may also help some men who aren't producing sperm normally because of a hormone imbalance.
Sources: Christopher Williams, MD, author of The Fastest Way to Get Pregnant Naturally; 100 Questions and Answers About Infertility, by John D. Gordon, MD, and Michael DiMattina, MD; The Fertility Diet, by Jorge E. Chavarro, MD, and Walter C. Willett, MD; American Society for Reproductive Medicine sections on infertility; National Women's Health Information Center; MayoClinic.com sections on infertility; Intelihealth.com sections on infertility; University of Maryland Medical Center sections on infertility
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