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"With so many exciting advances in the treatment of infertility today, it is easy to lose sight of the importance of the evaluation of the male. Any man with an abnormal semen analyses should be evaluated by a male infertility specialist to ensure there is not a more serious medical condition responsible for the abnormalities seen."
Sarah K. Girardi, M.D., F.A.C.S.
Chief, Division of Infertility and Female Urology, North Shore University Hospital
Dr. Girardi completed a fellowship in male infertility and microsurgery at The New York Hospital/Cornell Medical Center and has published numerous articles, books chapters, and reviews on male infertility. In addition, she is Clinical Associate Professor of Urology and Clinical Associate Professor of Reproductive Medicine at Cornell Medical Center.
Infertility is the inability to conceive after at least one year of unprotected intercourse. Since most people are able to conceive within this time, physicians recommend that couples unable to do so be assessed for fertility problems.
Roughly 1 out of 6 couples in the United States are infertile. In addition, in up to half of those couples a male factor is identified. In some cases the problem may be as simple as a recent infection or illness that has temporarily impaired sperm quality. In other cases, there is a physical condition that impairs sperm quality and can be corrected. In rare cases, a serious medical condition is responsible for infertility.
Therefore, it is very important that the male partner be evaluated early before the female partner goes through extensive testing. The evaluation is as simple as a physical examination and a semen analysis. (See "Fear of Semen Analysis" in the next issue.)
Causes of infertility include the following:
- Varicocele (abnormally dilated veins associated with one or both testes)
- Abnormal development of the reproductive system such as failure of testes to descend into the scrotum (cryptorchidism) or absence of one or both testicles (anorchism)
- Medical disease such as cystic fibrosis, sickle cell anemia, or sexually transmitted diseases (STDs)
- Hormonal dysfunction such as testosterone deficiency caused by a disorder in the hypothalamic-pituitary-gonadal axis
- Infection (e.g., prostatitis, epididymitis, orchitis) can cause irreversible infertility if they occur before or at the time of puberty
- Injury (e.g., testicular trauma)
- Medications to treat high blood pressure (hypertension) and digestive disease
- Metabolic disorders such as hemochromatosis (affects how the body uses and stores iron)
- Systemic disease (high fever, infection, kidney disease)
- Testicular cancer
Other Issues To Consider:
- Anyone who has pursued an infertility evaluation or reads about male infertility knows that the choice of undergarments for male patients can have an impact on fertility. The reason is that any thermal effects to the testicles will result in impaired sperm production. Put another way, for optimal sperm production to occur, the sperm need to reside in a cool environment. To the extent that briefs are restrictive and keep the testicles closer to the body than boxers, briefs may indeed provide a warming effect to the testes. For this reason, boxers are recommended over briefs. In addition, men are asked to avoid any other potentially thermic effects to the testes. These include avoiding prolonged hot baths, hot tubs, tight-fitting or restrictive clothing, and limiting vigorous exercise to less than 90 minutes per workout.
- Many studies support the role of vitamins C and E as beneficial to sperm quality. Vitamins C and E function as antioxidants and are protective to sperm. Beware of herbal supplements, however. Some of the supplements added to multivitamins have effects on hormone receptors and may actually be harmful to sperm quality. You are better off using a vitamin supplement with no herbal additives.
Concerned about male infertility? Please fill out our male infertility questionnaire.
To make an appointment for an infertility consultation with Dr. Girardi, please call 516.320.7040.
To learn more about male infertility, read our male infertility newsletter.
For information on vasectomy and vasectomy reversal, please visit our vasectomy services page .