Male Infertility - What Should You Know?

Approximately 15 percent of couples are infertile. This means they aren't able to conceive a child even though they've had frequent, unprotected sexual intercourse for a year or longer. In about half of these couples, male infertility plays a role.

Male infertility is 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.

Not being able to conceive a child can be stressful and frustrating, but a number of male infertility treatments are available

The Causes of Male Infertility

Male infertility has many causes - from hormonal imbalances, to physical problems, to psychological and/or behavioral problems.  Moreover, fertility reflects a man’s “overall” health.  Men who live a healthy lifestyle are more likely to produce healthy sperm.  The following list highlights some lifestyle choices that negatively impact male fertility - it is not all-inclusive:

· Smoking significantly decreases both sperm count and sperm cell motility. 
· Prolonged use of marijuana and other recreational drugs. 
· Chronic alcohol abuse. 
· Anabolic steroid use causes testicular shrinkage and infertility. 
· Overly intense exercise produces high levels of adrenal steroid hormones which cause a testosterone deficiency resulting in infertility. 
· Inadequate vitamin C and Zinc in the diet. 
· Tight underwear increases scrotal temperature which results in decreased sperm production. 
· Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury,  benzene, boron, and heavy metals 
· Malnutrition and anemia. 
· Excessive stress! 

Modifying these behaviors can improve a man’s fertility and should be considered when a couple is trying to achieve pregnancy.

Hormonal Problems:

A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: 

· The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates the hormonal pathway that causes testosterone synthesis and sperm production. A disruption in GnRH release leads to a lack of testosterone and a cessation in sperm production.

· The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates in the hormonal pathway responsible for testosterone and sperm production.

· The testes' Leydig cells may not produce testosterone in response to LH stimulation. 

· A male may produce other hormones and chemical compounds which interfere with the sex-hormone balance.

The following is a list of hormonal disorders which can disrupt male infertility:

Hyperprolactinemia: 
Elevated prolactin, a hormone associated with nursing mothers, is found in 10 to 40 percent of infertile males.  Mild elevation of prolactin levels produces no symptoms, but greater elevations of the hormone reduces sperm production, reduces libido and may cause impotence.  This condition responds well to the drug Parlodel (bromocriptine).

Hypothyroidism: 
Low thyroid hormone levels can cause poor semen quality, poor testicular function and may disturb libido.  May be caused by a diet high in iodine.  Reducing iodine intake or beginning thyroid hormone replacement therapy can elevate sperm count.  This condition is found in only 1 percent of infertile men.

Congenital Adrenal Hyperplasia: 
Occurs when the pituitary is suppressed by increased levels of adrenal androgens.  Symptoms include low sperm count, an increased number of immature sperm cells, and low sperm cell motility.  Is treated with cortisone replacement therapy.  This condition is found in only 1 percent of infertile men.

Hypogonadotropic Hypopituitarism: 
Low pituitary gland output of LH and FSH.  This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and Leydig (testosterone producing) cells to deteriorate.  May be treated with the drug Serophene.  However, if all germ cells are destroyed before treatment commences, the male may be permanently infertile.

Panhypopituitafism: 
Complete pituitary gland failure lowers growth hormone, thyroid-stimulating hormone, and LH and FSH levels.  Symptoms include:  lethargy, impotence, decreased libido, loss of secondary sex characteristics, and normal or undersized testicles.  Supplementing the missing pituitary hormones may restore vigor and a hormone called hCG may stimulate testosterone and sperm production.

Symptoms

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance or a condition that blocks the passage of sperm may cause signs and symptoms. Male infertility signs and symptoms may include:

1. The inability to conceive a child
2. Problems with sexual function - for example, difficulty with ejaculation or difficulty maintaining an erection (erectile dysfunction)
3. Pain, swelling or a lump in the testicle area
4. Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
5. Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

Tests and diagnosis

Many infertile couples have more than one cause of infertility, so it's likely you will both need to see a doctor. It may take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. Infertility tests can be expensive and may not be covered by insurance — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

1. General physical examination and medical history. This includes examining your genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor may also ask about your sexual habits and about your sexual development during puberty.
2. Semen analysis. Semen is generally obtained by masturbating and ejaculating into a special container at the doctor's office. Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections. Often sperm counts fluctuate from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.

Your doctor may recommend additional tests to help identify the cause of your infertility. These can include:

1. Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see obstructions or other problems in the testicles and supporting structures.
2. Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
3. Hormone testing. Hormones produced by the pituitary, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems may also contribute to infertility. A blood test measures the level of testosterone and other hormones.
4. Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
5. Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.
6. Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.
7. Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm. You are especially likely to have anti-sperm antibodies if you've had a vasectomy reversal.

Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there's any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility.