Irene Souter, MD: Infertility & Environmental Impact on Reproductive Health
Episode #54 of the Charged podcast
Male infertility means that a man has a problem with his reproductive system. It means he can't start a pregnancy with a female partner. Read on to learn about causes, diagnosis, and treatment.
The Massachusetts General Hospital Fertility Center's Cryopreservation Program offers the latest assisted reproductive technology (ART), including cryopreservation, in a highly individual, private setting.
The Male Infertility Program at the Massachusetts General Hospital Fertility Center helps couples conceive by using the least invasive treatment approaches possible.
The Preimplantation Genetic Testing Program at Massachusetts General Hospital's Fertility Center helps couples with an increased risk for a specific genetic abnormality to have a child unaffected by that particular disease.
Infertility is a disease of the reproductive system. It makes a person unable to have children. It can affect a man, a woman, or both. Male infertility means that a man has a problem with his reproductive system. It means you can't start a pregnancy with your female partner.
Natural male reproduction depends on several things.
You must be able to:
Make healthy sperm that can fertilize the egg
Have an erection and ejaculate so the sperm reaches the egg
Problems with either of these may mean you have infertility. Below are some of the main causes of male infertility.
Problems with making healthy sperm are the most common causes of male infertility. Sperm may be immature, abnormally shaped, or unable to swim. In some cases, you may not have enough sperm. Or you may not make any sperm. This problem may be caused by many different conditions, including:
Infections or inflammatory conditions. One example is infection with the mumps virus after puberty.
Hormone or pituitary gland problems
Immune problems in which you make antibodies against your own sperm
Environmental and lifestyle factors. These include tobacco use, heavy alcohol use, marijuana or steroid use, or exposure to toxins.
Genetic diseases, such as cystic fibrosis or hemochromatosis
Anything that blocks the genital tract can stop the flow of semen. This could be a genetic or birth defect. Infection or inflammation from a sexually transmitted disease can also block semen. Other causes include scar tissue from surgery or twisted, swollen veins in the scrotum.
Other factors may include erectile dysfunction or premature ejaculation. These include liver or kidney disease, or treatment for seizure disorders.
You may be more likely to have male infertility if you have had:
Past inflammation of the prostate or past genital infections
Injury to or twisting (torsion) of the testicles
Early or late puberty
Genital exposure to high temperatures
You may also be at risk if you take certain prescription medicines. These include medicines for ulcers, psoriasis, depression, and high blood pressure.
You may have male infertility if your female partner has not become pregnant after you have tried for 1 year. This means 1 year of regular sex without any birth control.
Your healthcare provider will test both you and your partner to find the cause of infertility.
Your healthcare provider will review your health history and do a physical exam. Other tests for male infertility may include:
Sperm count (semen analysis). At least 2 semen samples are taken on separate days. Your provider will check the semen and sperm for many things. These include how much semen you make, how uniform it is, and how acidic it is. Your provider will also look at how many sperm you make, how well they move, and what shape they are.
Blood tests. Your provider may use blood tests to check hormone levels and rule out other problems.
Other tests. Your provider does these tests to find the cause of sperm defects or health problems of the male reproductive system. For instance, imaging tests such as an ultrasound may be used to look at your testicles, blood vessels, and structures inside the scrotum.
Testicular biopsy. If semen analysis shows that you have only a few sperm or no sperm, your provider may remove a small piece of tissue (biopsy) from each testicle. The sample will be checked under a microscope.
Treatment depends on what is causing your infertility.
This treatment involves helping your partner get pregnant. It may be through:
Artificial insemination. This method puts many healthy sperm at the entrance of the cervix or right into the partner's uterus. The sperm can then make their way to the fallopian tubes.
IVF, GIFT, and other methods. In vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) work like artificial insemination. Your provider collects your sperm. Then your provider mixes your partner’s eggs with a lot of high-quality sperm. Your provider may mix the eggs and sperm in the lab or in your partner’s fallopian tube.
Intracytoplasmic sperm injection (ICSI). Your provider injects a single sperm into an egg. Fertilization then takes place under a microscope. Your provider puts the fertilized egg in your partner’s uterus.
Hormone treatment may help you if you have a hormone disorder causing your infertility. Hormone imbalances can affect how sperm develop. They may be caused by a problem in how the hypothalamus, pituitary gland, and testes interact. Treatment may include gonadotropin therapy or antibiotics.
Your provider may use surgery to fix problems that keep sperm from being made, matured, or ejaculated. Surgery to remove swollen veins in the scrotum (varicocele) can sometimes improve the quality of sperm. You may need surgery to reconnect or open blocked tubes that allow sperm to be ejaculated.
Check with your healthcare provider about any questions or concerns you have about your condition.
Male infertility means a man is not able to start a pregnancy with his female partner.
Male infertility can have many causes. You may not make enough sperm or healthy sperm. You may have a genetic problem like cystic fibrosis. You may have a blockage in your genital tract.
You may be more likely to have male infertility if you have had genital infections, injury to your testicles, or early or late puberty.
Treatment depends on what is causing your infertility. Treatments include artificial insemination, medicines, and surgery.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
The purpose of this study was to quantify and describe the amount of waste generated by an Emergency Department, identify deviations from waste policy and explore areas for waste reduction.
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