The wish to establish a family is a primal desire; however for 10-15 percent of couples in the United States this may not be possible. Every year over 1.2 million patients seek help in the arena of conception, often frustrated and confused.
Infertility is defined as the inability to conceive following 12 months of regular intercourse without the use of contraception. This period of time is shortened to 6 months for women 35 and older, as fertility gradually declines with age. Although, most assume that fertility is a female health problem, 50% of couples are actually affected by male factor infertility.
Male infertility is most commonly due to problems with sperm; either quantity, motility, or size and shape can impacts one’s ability to conceive. One of the most common cause of male infertility is a varicocele, which is found in 40% of infertile men. A varicocele is a group of dilated veins in the scrotum. For most men they don’t cause any issues and thus require no intervention. Some, however, can experience pain or impaired fertility. The dilated vessels increase the temperature of the scrotum, resulting in testicular damage and impaired sperm production. For that reason, when a couple is having difficulty conceiving and all other causes of an abnormal sperm analysis have been ruled out repair of the varicocele is recommended.
Many chronic conditions can also impact ones fertility. For instances, diabetes, which affects over 25 million Americans, can result in abnormal ejaculation. Poor sugar regulation can result in nerve damage including those which are responsible for coordinating ejaculation. Liver cirrhosis can also impact fertility, as the condition is often associated with hormonal imbalances that can interfere with sperm production.
Additionally, drugs and environmental exposures can interfere with viable sperm production. Although it is well known, that drugs like alcohol, marijuana, heroin and cocaine can all impact the quality and quantity of sperm, even some prescription drugs can interfere with normal production. Antibiotics, anti-acids, anti-depressants, gout, and blood pressure medications can also impact fertility. Similarly, exposure to heavy metals, such as lead and mercury, can influence sperm production.
As fertility can be impacted by so many variables, every clinical work-up begins with a detailed history and physical exam. Although at times tedious, the questions asked by the physician help direct the next steps by narrowing the possible diagnoses and subsequent treatments. Semen analysis is a critical step in the work-up of an infertile couple. Semen needs to be collected at least 3 months following any stressful events or febrile illnesses, as a fever can impair sperm production for up to 3 months. These samples will be analyzed for several parameters that affect fertility, such as semen volume, sperm concentration, shape and size. The results of this analysis will greatly help narrow the possible causes.
As with most sensitive health issues, myths and rumors are common place regarding male infertility. While some of these have truth behind them not all are based in reality. For instance, one wives’ tale connects long bicycle rides with decrease sperm production, however there is no conclusive evidence that supports this. On the other hand, another common belief that saunas can reduce fertility is in fact true. Saunas and steam rooms increase body temperature to a level that stifles sperm production. Similarly, keeping your laptop on your lap can decrease sperm production secondary to the heat produced by the computer. It is best to rearrange your workstation or use a laptop fan to keep the area cool. Lastly, although there is an ongoing debate on whether the type of underwear one wears, boxers or briefs, can impact sperm, research has not been able to prove that the type of underwear impacts production. Most important, however, is to discuss your concerns with a qualified physician, this is the only way to ensure your questions will be answered in an accurate manner. Also when coping with infertility it is important to approach your concerns with a broad team. You will need to work with many disciplines of medicines, urology, gynecology, and psychiatry and building a team that you trust is key to effective treatment.
