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Fertility Problems in Men

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Posted by on Friday, March 18, 2011, 4:23
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Fifty percent of fertility problems that couples experience are cause by a problem with male fertility. There are several things that can cause fertility problems in men. Some of the most common can include low sperm motility, low sperm count, abnormal sperm, sperm allergies, and varicocele.

If sperm do not move forward and at a reasonable rate, conception is much less likely to occur. This is referred to as low sperm motility. Low sperm mobility can be caused by hormonal changes, medications, drug use, alcohol use, excessive caffeine, smoking, and testicular injury. IN addition, sperm motility can be affected by temperature. If the temperature of the testicles is too high, sperm motility is reduced. This can be caused by hot tubs, saunas, heated waterbeds, or even the wearing of tight underwear and tight pants.

Fertility Problems in Men
Fertility Problems in Men

If a man’s semen does not contain a sufficient number of sperm, he has a low sperm count. Low sperm count can be caused by many of the same things that can cause low sperm motility: hormonal changes, medications, drug use, alcohol use, excessive caffeine, smoking, testicular injury, and testicular overheating are all risk factors.

Having a high number of sperm that are not shaped correctly can affect fertility. In addition to the above causes, exposure to chemicals and heavy metals can cause abnormal sperm.

There have been documented cases of sexually active men and women that can develop “sperm antibodies” that can impair sperm functions. This is often called a sperm “allergy”. In these instances, the solution is almost always assisted reproduction such as IVF or IUI.

When the vein that supplies the testicle is enlarged, it is known as varicocele. A varicocele can cause the testicles to be warmer than usually, affecting sperm count and motility. A varicocele can generally be corrected through urological surgery.

If you are having trouble trying to conceive, it is important for the man to provide the physician a complete health history, particularly including use of medications, drugs, alcohol, caffeine, cigarette smoking and exposure to chemicals or heavy metals. Your physician can then determine the best treatment. Treatment can include:

- Lifestyle changes, such as decrease in smoking, alcohol, caffeine, drugs, there is no medical or drug treatment that is currently effective for the treatment of low sperm count, low motility or abnormal sperm.

- Occasionally a physician will try hormone treatment, such as clomiphene citrate (Clomid or Serophene). Clomid is a fertility medication used in females, and a limited amount of research suggests that it can positively affect sperm count or motility. Use of this medication for male infertility is controversial.

Male Infertility Cause:  Varicoceles
One of the main functions of the testicles is to produce sperm . . . and lots of them. From puberty on, the average male produces 50,000 sperm per minute, or about 1,000 per second. Problems arise when one or more veins in a scrotum sac become enlarged. Called varicoceles, these enlargements are caused by a faulty vein valve that allows blood to back up. Varicoceles are found in 35 to 40 percent of men who are screened for infertility. And while varicoceles can vary in size, the thinking is that those that are large enough to be detected during a physical examination affect fertility, whereas the smaller ones found only through imaging techniques usually don’t cause problems.

Doctors aren’t exactly sure why varicoceles cause infertility, but they do have a few theories: One is that the extra blood increases the internal temperature of the testes, which in turn affects sperm production and quality. Studies also show that men with varicoceles experience a drop in testosterone levels (testosterone, the male hormone, is necessary for sperm production). Still another theory is that poor drainage in the veins leaves the testicles more exposed to toxins, which might damage sperm quality and production.

Left untreated, varicoceles can lead to oligospermia (few sperm being produced) or azoospermia (no sperm). If a varicocele is detected during a physical examination, your doctor will probably recommend surgical repair. The surgery can be done on an outpatient basis under local anesthesia. On average, 50 to 60 percent of partners of men who have this surgery become pregnant within two years.

Male Infertility Cause:  Obstructions
In some cases, a man makes sperm but has a blockage in his reproductive tract that prevents the sperm from getting where they need to go. Among infertile men, the most common hereditary cause for a fertility-threatening obstruction is a condition called congenital bilateral absence of the vas deferens (CBAVD). Men with CBAVD are born without any vas deferens—the tubes which lead from each testicle to the penis—making it impossible for sperm to travel. About one in every 1,000 men has CBAVD.

Chris Bortlik, 30, of Medford, Massachusetts, is one of these men. He and his wife Marisa were married in June of 2000, and started trying to get pregnant about a year and a half later. After six months with no success, his wife mentioned the problem to her obstetrician, who suggested that both she and Chris see a specialist. Blood tests revealed that Chris had CBAVD.

“At first, I assumed they’d be able to take a vein from somewhere else to try to fix the condition, says Bortlik. “But the vas deferens is more complex, so it’s impossible to create or transplant one.” Instead, Chris’ doctor told him about a technique called testicular sperm extraction, or TESE. Under local anesthesia, a surgeon removed a pea-sized sample of sperm-containing tissue from Chris’ testicles. Then in a second procedure, called ICSI—intracytoplasmic sperm injection—a single one of those retrieved sperm was injected directly into one of Marisa’s eggs for fertilization. Ultimately it would take seven rounds of in vitro fertilization (IVF) for Marisa to become pregnant. The Bortliks welcomed baby Kayla last September.

A technique called MESA (microsurgical epididymal sperm aspiration) is also used to treat men with CBAVD. Unlike TESE, the MESA technique removes only sperm, and not testicular tissue. “It yields far more sperm, and has higher pregnancy rates,” says Dr. Goldstein. “My results with this technique in men with CBAVD yielded 100 percent pregnancy rates overall, with 70 percent per IVF cycle.”

Obstructions can also result from bacterial infections (which often cause no symptoms) and sexually transmitted infections, including chlamydia and gonorrhea, which can lead to scarring of the epididymis (a mass of convoluted tubes in the testes). These scars can create blockages that cause infertility by preventing sperm from getting where they need to go. Microsurgical techniques can correct the scarring and eliminate the blockage in 75 percent of affected men.

Male Infertility Cause:  Genetic Disorders
One of the most common fertility-threatening chromosomal abnormalities in men is Klinefelter’s Syndrome, which affects one out of every 500 males. The condition occurs when a boy inherits one or more extra “X” (female) chromosomes. Symptoms can vary, but often include breast enlargement and small testes. Most men affected with the condition are unable to produce sperm, although some do produce small amounts. A man with Klinefelter’s Syndrome who wishes to father a child can have a test to check for sperm production. If sperm is present, even in small amounts, it can be extracted and then inserted directly into an egg for fertilization.

In about 10 to 15 percent of cases of male infertility involving no blockage and no sperm, genetic testing will reveal a missing sex chromosome. The condition is called “micro Y deletion,” for a missing piece of the Y—male—chromosome. A new technique that involves removing tiny pieces of testicle tissue containing minute amounts of sperm has made it possible for half of these men to overcome infertility and father a child.

Male Infertility Cause:  Sperm Antibodies
In some cases, a man’s own body will produce antibodies that severely weaken his sperm, making it difficult for them to move and penetrate an egg. Identifying the reason for the antibodies helps determine which type of fertility treatment to pursue. If the doctor finds that an infection of the epididymis or prostate is responsible, antibiotic medication can often clear things up. If one of the reproductive ducts is damaged from an injury, surgical reconstruction might be able to correct the problem and restore fertility. And when it’s impossible to pinpoint the cause for the anti-sperm antibodies, steroid drugs can be used to stop the body from rejecting sperm.

Male Infertility Cause:  Hormonal Irregularities
In some cases, infertility in men can be attributed to a lack of male hormones. Hypogonadism is a condition in which the testicles produce very little or no testosterone because the pituitary hormones that drive the testicles are missing. Without adequate levels of the hormone, a male can’t start puberty, which signals the onset of sperm production. Treatment for hypogonadism involves drug therapy to jumpstart testosterone production, including regular doses of medications such as human chorionic gonadotropin (hCG). It takes approximately six months to two years to complete the cycle of drug therapy and improve fertility.

When Infertility Can’t be Fixed
Kevin Garton, 40, of Vienna, Virginia, was born with a defect that left him with undescended testicles. He had surgery in the third grade to correct the condition. But by then it was too late and the damage to his genitals had left him unable to produce sperm. (When the defect is corrected within a year or so of birth, fertility is usually not seriously impaired.) “We chose to go down the anonymous sperm donor route,” says Garton, who’s now the proud father of three children, ages 8, 6 and 1. “For my wife and I it just became a natural, beautiful, and normal way to do things.” For more information on sperm donor banks, check out www.fertilityplus.org.

Recent advances in microsurgery mean that now many men like Kevin Garton can be helped to be fathers. “Using testicular sperm extraction with microdissection, we can find sperm in 60 percent of men with zero sperm counts and a history of undescended testes,” says Dr. Goldstein. “And with each ICSI and IVF try, 40 percent of these men can help their partners achieve a pregnancy.”

Thanks to genetic and hormone research, advancements in microsurgery, and new techniques such as ICSI , most men dealing with infertility today can ultimately be helped to become fathers.

Lifestyle and Behavior
What men choose to drink, smoke, or medicate with can have a direct effect on their fertility. Scientists now estimate that a man’s health or habits can play a role in about 40 percent of infertility cases. For instance, a recent study of over 1500 Danish men found that being underweight or overweight can significantly lower a man’s sperm count and concentration. For men who want to lead a fertility-friendly lifestyle, consider the following:

Even though alcohol may have some health benefits (red wine, for instance, has been shown to reduce the risk of heart disease), consuming large amounts of wine, beer, or hard liquor can affect the quality of sperm and even lower the level of testosterone (necessary for sperm production). How much is too much when you’re trying to conceive? “I recommend men limit alcoholic beverages to no more than two drinks twice a week,” says Dr. Goldstein. Heavy drinkers who cut back on alcohol intake should see an improvement in the quality and production of sperm in about three months.

Both cigarettes and marijuana are toxic to the testicles and cause poor sperm quality. It takes about three months for the levels of nicotine-related chemicals to start diminishing in the blood after a smoker quits.One recent study found that active marijuana use adversely affects fertilization by causing sperm to “poop out” before they get close to the egg. Abstaining from marijuana for three months allows healthy sperm to regenerate.

Drugs And Environmental Toxins
Calcium channel blockers, which are used to treat heart disease and high blood pressure, can destroy a sperm’s ability to penetrate an egg. Methotrexate, an arthritis drug, can decrease sperm count, as can the anabolic steroids used by some athletes. Chemotherapy drugs, pesticides, and other chemicals may damage sperm production. Illegal drugs such as cocaine can lower testosterone levels, sperm production, and libido. Check with your doctor for a complete list of drugs that might impair fertility.

Research has shown that chronic stress can interfere with everything from a man’s sex drive, erection and ejaculatory capabilities to his sperm count and quality. Of course, it’s hard for men not to feel stressed when they’re dealing with infertility. Regular exercise, adequate sleep, and good nutrition can go a long way toward combating the ill effects of stress, and when these lifestyle changes aren’t enough, counseling sessions with a licensed psychologist or psychiatrist may be helpful.

Doctors tell prospective dads to steer clear of any clothing (such as tight-fitting nylon underwear or exercise shorts) or activities (soaking in a very hot tub, sitting for hours in a car or truck, long-distance bike riding) that heat up the testicles. Similarly, studies have found that the radiation emitted from cell phones, and the heat from laptop computers, electric blankets and waterbeds, can all affect a man’s fertility. For most men, these activities will probably not affect sperm count or quality enough to prevent conception. But for couples who are having difficulty conceiving, changing any of these factors can sometimes make a difference.

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