The wish to establish a family is a primal desire - but for 10-15 percent of couples in the United States, this may not be possible.
Every year, more than 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 percent 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 percent of infertile men. A varicocele is a group of dilated veins in the scrotom. 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 more than 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, antacids, antidepressants, 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.
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