Definition

Infertility is not being able to conceive after a year of regular, unprotected sex. About one-third of infertility is caused by male factors and one-third are caused by female factors. In the remaining cases, the cause is unknown or is related to problems with both partners.

Men are considered infertile if they:

• Produce too few sperm cells
• Produce sperm cells of poor quality
• Have chronic problems with ejaculation

The Male Reproductive System

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Causes  ^

Portions of the brain called the pituitary gland and hypothalamus, as well as male reproductive organs such as the testes affect fertility in men. Problems in any of these areas may decrease fertility.

In about half of the cases, a cause cannot be found. Some factors that can contribute to infertility include:

• Genetic diseases such as Klinefelter syndrome and Sertoli-Leydig cell syndrome
• Exposure to workplace chemicals or heavy metals, such as primarily lead and cadmium
• Tobacco and marijuana use
• Enlarged veins within the scrotum—varicocele
• Abnormal hormone levels
• Infections
• Physical abnormalities
• Cancer
• Medications
• Obesity
• Chronic diseases such as sickle cell anemia
• Excessive physical activity
• Anti-sperm antibodies

Risk Factors  ^

Factors that may increase your chance of developing infertility include:

• Exposure to toxic chemicals or heavy metals, such as lead
• Liver disease
• Nicotine use, long-term marijuana or cocaine use, steroid use, opioid use, and certain prescription drug use
• Exposure to diethylstilbestrol (DES) in the during fetal development
• Chemotherapy
• Malnutrition
• Overheating of the testicles
• Cystic fibrosis
• Klinefelter syndrome
• Kartagener syndrome
• Diabetes
• Spinal cord injuries
• Multiple sclerosis
• Brain tumors, pituitary tumors
• Radiation treatment
• Past infections, including sexually transmitted diseases (STDs), mumps, and prostatitis
• Birth defects of the male reproductive system, including history of undescended testicles
• Obesity, high body mass index

Symptoms  ^

Inability to have a child after one year of trying to conceive.

Diagnosis  ^

During the first visit, you and your partner will both be evaluated. You will be asked about your symptoms, medical history, and work history. Your doctor will look for potential exposure to certain chemicals. Your doctor will also look for physical problems that might cause infertility.

Your bodily fluids and tissues may be tested. This can be done with:

• Blood tests
• Semen analysis
• Biopsy

Images may be taken of your bodily structures. This can be done with:

• Ultrasound
• X-rays

Other tests may include:

• Fertilization tests—to determine how well the sperm can penetrate an egg
• Post-coital test—to check if your sperm is compatible with the mucus in your partner's cervix

Treatment  ^

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Prevention  ^

To help reduce your chances of infertility:

• Avoid:
  • Use of tobacco, marijuana, opiates, and anabolic steroids
  • Exposure to harmful chemicals and heavy metals
  • Excessive use of alcohol
• Protect yourself from STDs by using condoms. Minimize the number of sexual partners you have.