Male Infertility. Penis. Epididymis

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1 Male Infertility Introduction Infertility is a term used when a man is unable to get a woman pregnant. But the term is only used after at least one year of trying. Infertility is a common problem. About a third of the time, infertility is because of a problem with the man. One third of the time, it is a problem with the woman. Sometimes no cause can be found. This reference summary will help you understand male infertility. It talks about causes and risk factors. It also explains tests that may be used to diagnose the problem. Treatment options are also covered. The Male Reproductive System This section talks about the male reproductive organs. They are located both inside and outside of the body. The organs are found in the pelvic area. The male reproductive organs are: The testicles. The duct system, made up of the epididymis and the vas deferens. The accessory glands, which Penis include the seminal vesicles and Vas Deferens prostate gland. The penis. Epididymis The testicles are egg-shaped glands. Testicles They sit in a soft pouch called the scrotum. The testicles have 2 main roles: Making sperm, which are the male reproductive cells. Making hormones, including testosterone. 1

2 The epididymis and the vas deferens make up the duct system. They are found alongside the testicles. The epididymis is a set of two tubes. Each tube connects a testicle to the vas deferens. This system is located in the scrotum. The scrotum is a pouch that hangs outside the pelvis. The vas deferens is a tube surrounded by muscle. It transports sperm to the urethra. The urethra is the tube through which urine and semen exit the body. Semen is a fluid that carries sperm. Semen is released through the urethra and out of the penis when a man reaches sexual climax. Testicles need to be kept cooler than the rest of the body to make sperm. The scrotum helps control temperature by changing size. When the body is cold, the scrotum shrinks to hold body heat. When the body is warm, the scrotum becomes larger to get rid of extra heat. These changes are controlled by the brain and nervous system. The accessory glands are the seminal vesicles and the prostate gland. These glands keep sperm healthy. They also make fluids. The fluids help the sperm move. The seminal vesicles are sac-like glands. They are located near the bladder and are attached to the vas deferens. These glands help the body produce semen. The prostate gland surrounds the ducts that push the semen into the urethra during ejaculation. The prostate gland also helps the body produce semen. The urethra carries semen to the outside of the body through the penis. It also carries urine from the bladder to the outside of the body. The penis is made up of two parts: the shaft and the glans. The main part of the penis is called the shaft. The tip of the penis is called the glans, or the head. At the end of the glans is an opening. Semen and urine exit the body through this opening after traveling through the urethra. The inside of the penis is made of a spongy tissue that can expand and contract. This is how a man gets an erection. Male Infertility Pregnancy is the result of a process that has many steps. Infertility can happen if there are problems with any one of those steps. Male infertility is a word that is used to describe a man who has not been able to get a woman pregnant. It is used only after at least one year of trying. 2

3 Infertility is not always just a man s problem. Both men and women can have problems that cause infertility. Nearly 15% of couples have problems trying to have a baby. Male infertility can be caused by problems with the body. It may also be caused by life choices. Sometimes environmental factors are at play. The next section talks about these causes in more detail. Causes There are many causes of male infertility. It can be caused by: Physical problems. Hormonal problems. Lifestyle choices. Environmental factors. Male fertility is a complex process. For pregnancy to happen, sperm must: Be healthy. Be carried into the semen. Be plentiful, meaning that many are carried in the semen. Have the right shape and be able to move. A man must have healthy sperm to get his partner pregnant. To make healthy sperm, at least one of the testicles must work correctly. The male body must also make testosterone and other hormones. They tell the body to make sperm and keep it healthy. Sperm have to be carried in the semen to get a woman pregnant. After sperm are made in the testicles, tubes transport them to the penis. During this trip, they mix with semen. A man also needs to have a high sperm count. If the number of sperm in his semen is low, it lowers the chances of pregnancy. It is less likely that one of the sperm will fertilize a partner's egg. A high sperm count means 15 million sperm per milliliter of semen or 39 million per ejaculate. The sperm must also be the right shape. This is important for the sperm to move. If the movement or shape of the sperm is not normal, they may not be able to reach or enter a partner's egg. 3

4 Special veins drain the testicles to help them cool. If these veins become swollen, it is known as a varicocele. It is a common cause of male infertility. When the testicles can't cool, it can lead to a lower sperm count and fewer moving sperm. Infections can affect the amount of sperm made or sperm health. Some also cause scarring that blocks the passage of sperm. Examples include: Swollen testicles due to mumps. Swollen prostate. Sexually transmitted diseases, or STDs, like chlamydia and gonorrhea. Chlamydia is a curable STD caused by bacteria. In men, chlamydia can infect the epididymis. This can cause pain, fever and infertility. Gonorrhea is a curable STD caused by bacteria. In men, gonorrhea can cause discharge from the penis. It can also cause pain when urinating. It can affect the testicles and cause infertility. Infertility may be caused by retrograde ejaculation. Retrograde ejaculation happens when semen enters the bladder instead of leaving the urethra during ejaculation. Retrograde ejaculation may be caused by: Diabetes. Injuries to the spine. Certain medicines. Surgery in the pelvic area. Antibodies are special proteins meant to protect the body. But sometimes they can attack sperm. They try to get rid of the sperm because they think the sperm are dangerous to the body. This causes infertility. Tumors that form on or in the testicles can cause problems as well. They can harm the male reproductive organs. They can also affect the glands. This can stop the glands from releasing hormones needed for reproduction. The tumors may be cancerous. They may also be non-cancerous. While a baby grows in the womb, the testicles of some males do not descend. This means the testicles do not come down from the abdomen. When the urethra develops, it may open beneath the penis. Men with these problems may be infertile. 4

5 Low testosterone can cause infertility. This happens when the body does not make enough testosterone. Infertility can also be caused by low levels of other hormones. This disrupts the complex process of creating a baby. The tubes that carry sperm may become damaged by illness or injury. This may cause one or both of the tubes to become blocked. Then the sperm can't be carried out of the body. Men with certain inherited health problems may be born without these tubes. Some disorders passed from parent to child can cause problems with the male reproductive organs. These organs may not develop normally. Some of these disorders are: Klinefelter's syndrome. Kallmann's syndrome. Young's syndrome. Kartagener syndrome. Klinefelter s syndrome happens when a male is born with 2 X chromosomes and 1 Y chromosome. Normally, men are born with 1 X and 1 Y chromosome. Women are born with 2 X chromosomes. Kallmann s syndrome causes delayed or absent puberty. It also makes it difficult to smell. It is related to another health problem that affects the making of hormones that are important in sexual growth. Young s syndrome is a rare disease. It can prevent sperm from mixing with the rest of the semen. This is due to a physical blockage. No sperm can be carried in the semen. Kartagener syndrome is a disorder that is passed from parent to child. It affects cilia. Cilia are found in many parts of the body, including the reproductive system. This disorder can cause headaches and problems with fertility. Problems during sex may also cause infertility. These can include: Erectile dysfunction. Pain during sex. Premature ejaculation. Mental or emotional problems that interfere with sex. Erectile dysfunction is also known as ED. ED means problems keeping or maintaining an erection. It can cause problems with sex. Premature ejaculation means releasing semen before the penis enters the vagina. 5

6 Celiac disease is a disorder caused by an allergy to gluten. Gluten is a protein. It is found in certain grains. It can cause problems with fertility. Fertility may get better after eating a gluten-free diet. Some medicines lower the amount of sperm made by the body. This can cause infertility. Some examples are: Cancer medicines, like chemotherapy. Certain anti-fungal medications. Long-term anabolic steroid use. Some ulcer drugs. Testosterone replacement therapy. Overexposure to heat, toxins, and chemicals can lower the number of sperm made in the body. It can also make sperm less healthy. Some examples include: Heavy metal, such as lead. Industrial chemicals, such as pesticides. Radiation or x-rays. Sperm count can also become low if the testicles get too hot. This may happen with: Frequent use of saunas or hot tubs. Sitting for long periods of time. Wearing clothing that is too tight. Working with a laptop computer on your lap for long stretches of time. Some other causes of male infertility include: Alcohol use. Bicycling for a long time. Emotional stress. Illegal drug use. Work activities. Obesity, or being extremely overweight. Tobacco smoking. Repeating certain tasks at work may cause problems with fertility. People who perform shift work may also have a low sperm count. People with work-related stress may also be infertile. 6

7 Risk Factors This section talks about factors that increase a man s risk of infertility. These are called "risk factors." The following factors increase a male s chance of developing infertility: Being exposed to toxins. Being overweight. Having a prior vasectomy or vasectomy reversal. Having certain past or present infections. Using a laptop or other activities that heat the testicles. Smoking. Using alcohol. Using certain illegal drugs. A vasectomy is a surgery that some men have done to cause infertility. A man may choose to have this surgery if he no longer wants to have children. The surgery may be undone. But this is not common. Your risk is also higher if you have a family member with a fertility problem. Having health problems that can affect fertility also raises your risk. Taking certain medicines can raise your risk. Your risk is also increased if you undergo some medical treatments. One example is radiation used for treating cancer. Performing certain activities for a long time is also a risk factor. Examples are bicycling or horseback riding. The risk is even higher if you use a hard seat. A bicycle that is not adjusted correctly also raises the risk. When to Seek Medical Advice If you have been unable to get a woman pregnant after a year of trying, you may be infertile. See a health care provider if you think you may be infertile. You should also see a health care provider if you have: A history of testicle, prostate, or sexual problems. Erection or ejaculation problems. A history of groin, testicle, penis, or scrotum surgery. A low sex drive. Pain, swelling, or a lump in the testicle area. 7

8 Tests & Diagnosis There are tests that can show if you may have fertility problems. You will also have a physical exam. This can rule out certain causes of infertility. You will also be asked about your health history. This includes your sexual history. Your partner will also be asked these questions. It is important to know if one or both partners have fertility problems. Tests may also be done to check your semen and hormone levels. A sample of semen can be used to check the number and health of your sperm. A blood test can measure the level of certain hormones that are needed to make sperm. A scrotal ultrasound may be used. Sound waves are used to produce images inside the scrotum to look for obstructions or other problems. Also, a transrectal ultrasound can be used to look inside of the rectum for blockage in the tubes that carry semen. Genetic testing may help find problems with fertility. This is a type of blood test that can look for problems on chromosomes that were inherited at birth. A testicular biopsy is a test that involves removing samples from the testicle with a needle. Testing the samples will show if sperm production is normal. If it is, the problem may be caused by a blockage or another problem. Anti-sperm antibody tests are used to check for cells in the body that attack sperm. This happens when the immune system is fooled into thinking the sperm is harmful to the body. There are a number of other tests that can be used to check your sperm health. This includes how well your sperm survive after ejaculation and how well they can enter an egg. Talk to your health care provider about specialized sperm function tests. Treatment Treatment for male infertility depends on its cause. Treatments may include medicines or surgery. These are the most common treatments. Other methods are also available to help a woman get pregnant. Many times, more than one treatment is used at a time. 8

9 Health care providers consider the cause of infertility as well as other factors. Treatment plans may be based on: How long the couple has been trying to get pregnant. The age of the man and woman. The overall health of the partners. Preference of the partners. There are a number of medicines that treat low hormone levels. Other medicines can treat sexual problems. It is important to ask your health care provider about the benefits and risks of taking these medicines. Another treatment for infertility is assisted reproductive technology. It is a group of methods used to help couples who can't have a baby on their own. These methods work by getting sperm through normal ejaculation, surgery, or from donors. This depends on your specific case. It also depends on your wishes. Sperm is then placed in the female genital tract. The sperm may also be used to perform in vitro fertilization. In vitro fertilization is a process that fertilizes an egg with a sperm outside of the body. This is known as in vitro. The woman s egg must be removed and fertilized. It is then put into the uterus. Some cases of male infertility can be treated with surgery. If veins in the scrotum are too large, a minimally invasive surgery known as varicocele repair may help correct the problem. If an ejaculatory duct is blocked, a resection surgery can help clear the duct and allow semen to pass freely. Summary Male infertility is a term used when a man is unable to get a woman pregnant. But the term is only used after at least one year of trying. Infertility is a common problem. About a third of the time, infertility is because of a problem with the man. One third of the time, it is a problem with the woman. Sometimes no cause can be found. Male infertility can be caused by physical or hormone problems. It can also be caused by other factors. 9

10 Treatments may include medicines or surgery. These are the most common treatments. Other methods are also available to help a woman get pregnant. Many times more than one treatment is used at a time. Finding the cause of infertility can be a long and emotional process. But two out of three couples that are treated for infertility are able to have babies. 10