Couples commonly are considered infertile if they have been unable to conceive during one year of unprotected intercourse. This problem affects 15% of couples. Male infertility alone or in combination with a female infertility factor contributes to approximately 50% of these cases. With the newer diagnostic and therapeutic techniques available, many male infertility problems can be treated successfully by a urologist.

Conditions that May Lead to Infertility:

Advances in diagnostic techniques have enabled physicians to identify a number of conditions that may lead to male infertility.

A varicocele occurs when one or more veins carrying blood from the testicles become dilated. This allows blood to pool around the testicle, causing the temperature of the testicle to rise above normal. This appears to influence the number and motility of sperm produced by the affected testicle, causing infertility.

Obstruction in the ducts that transport sperm cells account for 7.4% of male infertility cases. These obstructions may result from scarring that develops as a result of infections, especially urinary tract infections, gonorrhea, and other sexually transmitted disease. In some cases, genetic defects and illnesses may create obstructions. Obstructions normally occur in one of these locations: the epididymis, the vas deferens or the ejaculatory duct.

About 6% of infertile men experience an early developmental problem known as undescended testicles. Even if this condition is corrected surgically in childhood, overall semen quality may be poor.

Past surgical procedures can interfere with fertility. These include bladder and other urinary tract surgery. In addition, men who undergo lymph node surgery for testicular cancer, especially if accompanied by chemotherapy or radiotherapy, are at risk for infertility.

Drugs and substances on our environment can bring on infertility either through a direct effect upon the testes, or by affecting hormones that cause sperm to be produced. These substances are classified as gonadotoxins. Among the more common gonadotoxins are radiation, chemotherapy agents, pesticides, excessive heat and drugs such as nicotine, alcohol, marijuana and steroids. In many cases, the gonadotoxic effects are reversible if one eliminates exposure to the toxin.

Medical Treatment

Infections usually can be treated effectively with antibiotics or patients who have a testosterone deficiency can receive medication to stimulate production.

Surgical Treatment

Varicocele Repair

Varicoceles are one of the most common factors accounting for poor semen quality. Surgical correction of a varicocele involves making an incision in the groin and exposing and tying off the abnormal vein. After completion of this procedure, blood no longer pools in the varicocele and proper blood flow is established. Successful surgery has been reported to improve semen quality in approximately 51 to 78% of patients.

Vasectomy Reversal

A microscopic surgical procedure can be conducted to reverse what was once thought to be a permanent sterilization (vasectomy). A vasectomy reversal, performed on an outpatient basis, involves bypassing the obstructed portion of the vas deferens. Depending on the circumstances and the length of time passed since the vasectomy, the pregnancy rates can be as high as 76%.

Assisted Reproductive Technologies

A man's semen can be specially processed so that dead cells and other natural impurities are removed. Then, through intrauterine insemination, the sperm are injected into the woman's uterus, where they may fertilize the egg and establish a pregnancy.

Another technique, in vitro fertilization, involves fertilizing the woman's egg in a laboratory dish and implanting the resulting embryo in her uterus.

A recent adaption of this process, gamete intrafallopian transfer, involves combining the egg and sperm in a dish and transferring them into the woman's fallopian tubes, where they can fertilize naturally.

A new technique, intracytoplasmic sperm injection, can achieve pregnancy with as few as one sperm.