Many different health and physical problems can lead to infertility. In about 40% of cases, the problem is in the testes, the glands that produce sperm and testosterone. Damage to the testes can result from infections such as mumps, treatments for cancer such as radiation, trauma or surgery.
Heat can affect sperm production. Heat damage may occur if one or both testes fail to descend from near the stomach into the scrotum. Many men have enlarged veins, around the testes, (varicoceles) that may also raise the temperature in the testes. If they are very large, varicoceles may cause low sperm production. Certain inherited diseases can cause low or no sperm production, or sperm that can’t swim or fertilize a woman’s egg.
In 20% of cases, the problem is a blockage in the sperm’s path from the testes, through tubes called the vas deferens, to the penis. This can be caused by scarring from an infection, a vasectomy, or cystic fibrosis. Backward movement of sperm into the bladder, instead of output through the penis, can also cause infertility. Also, any condition that causes low LH and FSH levels from the pituitary gland, such as a pituitary tumor, can result in low or no sperm production and low blood testosterone levels.
Evaluation of infertility is performed by an endocrinologist, where he will obtain a detailed history, and perform a thorough physical exam to look for signs of low testosterone or other conditions that affect fertility. A semen analysis will be obtained to look at the quantity, movement, and shape of the sperm. And blood tests looking for hormone deficiencies will be checked. Lastly, a scrotal ultrasound will be done to look for tumors or varicoceles.
Treatment for male infertility depends on the cause.
Surgery can repair a blockage in the sperm transport system, and also varicoceles.
Hormone therapy such as treatment with injections LH and FSH is usually successful. However, it may take a year or longer of hormone therapy to get enough sperm production and bring back fertility.
Lastly, assisted reproductive technologies include, inserting collected sperm into the womb, mixing sperm with an egg outside the body (IVF) or injecting a single sperm into an egg (ICSI).
To improve your chances of successful treatment, it is helpful to maintain a healthy lifestyle. Exercise often, eat a healthy diet, and do not smoke, or use drugs.
Dr. Nicholas Kaloudis is a highly regarded, board certified endocrinologist. He is a diplomate of the American Board of Internal Medicine and owner of EndoHealthMD, in Manhasset, NY. His center provides comprehensive specialty care using current evidence-based practices, and the latest advances in medical aesthetics. He holds an appointment as Associate Clinical Professor at North Shore University in Manhasset. He has received numerous awards, and he has published articles in the field of Endocrinology.
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