Mayo Clinic Guide to Fertility and Conception by Jani R. Jensen

Author:Jani R. Jensen
Language: eng
Format: epub
Publisher: Mayo Clinic Press
Published: 2015-02-28T00:00:00+00:00

CHAPTER 12

Male problems: Common and unusual

Male infertility is a common problem. It affects an estimated 35 to 75 percent of infertile couples. Because of this high rate for couples having difficulty achieving pregnancy, it’s recommended that both the male and the female partner undergo fertility evaluations.

At first glance it may seem that male infertility is pretty straightforward — it’s all about the sperm, right? Male fertility does, in fact, depend on a healthy production of sperm and unobstructed delivery of the sperm to the female vagina. The production of sperm, however, is a complex process. It requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, they spend months there maturing before delicate tubes transport them to be mixed with other seminal fluids and be ejaculated out of the penis.

Problems with any of these systems can affect sperm quantity or quality or both, and possibly reduce a couple’s fertility. Also, abnormalities in sperm shape (morphology) or movement (motility) can affect male fertility.

An evaluation for possible male infertility begins with a thorough history, and often a physical examination as well as a simple semen test, called a semen analysis. Because a semen analysis is relatively simple and noninvasive, it’s an excellent initial test that provides a large amount of information. Results of the analysis will determine if further testing is necessary, including blood or imaging tests or other procedures.

A wide range of factors may contribute to male infertility, and sometimes the cause of the infertility remains unknown. A man may have an abnormal semen analysis, and doctors may not be able to find a reason why (idiopathic male infertility). Or the results of the physical examination, laboratory tests and semen analysis may all come back normal, but a man may still experience infertility (unexplained male infertility).

Knowing this, it may be tempting to skip all of the diagnostic testing and go straight to using assisted reproductive technology (ART) to get pregnant faster. But a thorough male evaluation is important. An evaluation may uncover a condition that’s treatable. It can also identify serious health problems. In addition, testing and treatment can help increase the chances of success with ART, possibly preventing unnecessary procedures.

Also keep in mind that male fertility evaluations are performed within the context of the female partner’s health and age. For example, recommendations regarding treatment of various male conditions may vary if the female partner is older than age 35, to reduce unnecessary delays.

There are numerous causes of male infertility. In this chapter, we briefly discuss some of the more common findings associated with infertility and the role of various diagnostic tests. Treating male infertility, as with female infertility, is an emerging science. As you work with your care provider, talk with your partner about the process and the steps you’re willing to take as a couple to pursue pregnancy.

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