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There are also a number of sperm production problems that can contribute to infertility, including: Scrotal varicose veins (varicoceles)  Scrotal varicose veins (varicoceles) are swollen veins causing your testicles to get hotter and affect the production of sperm  These are treated with surgery  Testicular injury   Serious trauma to the testicles such as becoming twisted (torsion) can affect sperm production  Damage from playing sports or an accident can rupture the vessels that supply blood to the testicles  Previous injuries can’t be treated, but an ART treatment may help you to conceive Undescended testicles  In the uterus, baby boys’ testicles form in their abdomen and descend into their scrotum shortly before birth  Some men’s testicles don’t descend before they are born (cryptorchidism), although in these cases they usually drop in the first six months after birth  If left untreated, undescended testicles can affect fertility Testicular cancer  This happens when a malignant tumour in the testicle destroys testicular tissue  If undetected, testicular cancer can spread to other parts of the body  This is treated either by surgery, medication, radiotherapy or chemotherapy  However, cancer therapy can also damage sperm production  Genetic defects  Sometimes, genetic information on the Y chromosome (which is only present in men) is deleted (micro-deletions),6 which can reduce the production of sperm  Depending on where the micro-deletion is on the chromosome, this may be treated by surgically extracting sperm from part of your reproductive tract  However, some couples may need to consider using a donor sperm to conceive Mumps Contracting mumps (or mumps-related orchitis) after puberty may damage the sperm-producing cells in your testicles,  causing infertility or subfertility7 Usually, only one testicle is affected and if you have one functioning testicle you may not need treatment  However, some couples may need to use a sperm donor in order to conceive Anti-sperm antibodies  Anti-sperm antibodies are large proteins in your blood that are hostile to sperm  They can cause sperm to clump together and prevent them from swimming, or they may mistake sperm cells for an infection and try to destroy them  This can be treated using an ART treatment   Lifestyle   Sperm production can be affected by a range of lifestyle factors, including smoking, drinking, drugs, stress, overweight and unhealthy food Environmental factors can also affect your sperm quality, including overheating of your testicles, some sexual lubricants, the chemicals involved in certain manufacturing, painting or printing jobs   These factors are treated by making lifestyle changes, such as wearing loose clothing to avoid overheating Hormonal problems  Hormonal problems are rarely the cause of male infertility problems  However, some men have a natural deficiency in follicle-stimulating hormone (FSH) and luteinising hormone (LH), which prevents the testicles from producing testosterone or developing healthy sperm  Hormonal problems can usually be treated with medication Obstruction problems Blocked sperm ducts  Occasionally, male sperm ducts (epididymis and vas deferens) can become blocked, meaning that your semen doesn’t contain any sperm  This can be treated with surgery, or sperm may be surgically extracted from part of your reproductive tract  Vasectomy  Some men have had a previous vasectomy to stop them being able to conceive  This can sometimes be reversed using surgery  The procedure’s success depends on how long ago your vasectomy was performed  Previous infections  Infections can cause scarring or adhesions (organs sticking together) in your sperm ducts  This can usually be treated with surgery  Does age affect male fertility? Problems with sexual intercourse These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex. There is a consistent association of Mycoplasma genitalium infection and female reproductive tract syndromes.

These include advancing maternal age, severe male factor infertility (whereby ICSI can be used to fertilize the egg), and endometriosis, amongst many others. Regrettably, this often leads to untruly high expectations of assisted reproduction techniques (ART) [40]. Laparotomy with histopathology is usually indicated, because medical attempts at inducing ovulation (human chorionic gonadotropin, FSH, GnRH) are usually unrewarding. A bicornuate uterus is characterized by the presence of an indentation at the fundus. Up to 2 percent of men are thought to have suboptimal sperm.

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An Azoospermic Man with a do novo Point Mutation in the Y-chromosome Gene USP9Y. (PDF, 381 KB) Nature Genetics, 1999. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries. 8,45 Figure 1 provides an algorithmic approach to the evaluation of infertility.   Enlarge      Print Infertility Evaluation Figure 1. The opening improves the ability of the embryo to implant into the uterine lining.

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Management of ejaculatory failure: - Can be of great value as in retrograde ejaculation. Microsurgery in Pediatric Urology. (PDF, 13 MB) The National Foundation, 1977. A defect in any of these sperm structures may result in infertility that will not be detected by semen analysis.[60] Antisperm antibodies cause immune infertility.[23][24] Cystic fibrosis can lead to infertility in men. Author disclosure: No relevant financial affiliations. Assisted hatching: The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. Various parameters are measured, such as ejaculate volume and sperm density, quality, motility, and morphology.

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Effect of metformin on ovulation and reproductive outcomes in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Enzymatic Digestion of Testicular Tissue May Rescue the Intracytoplasmic Sperm Injection Cycle in Some Patients with Non-obstructive Azoospermia. (PDF, 66 KB) Human Reproduction, 1998. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.[62] However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.[63][64] Diagnosis[edit] If both partners are young and healthy and have been trying to conceive for one year without success, a visit to a physician or women's health nurse practitioner (WHNP) could help to highlight potential medical problems earlier rather than later. About 85 percent of male-female couples will be able to get pregnant within 12 months of trying. WHAT'S THE DIFFERENCE BETWEEN PRIMARY AND SECONDARY INFERTILITY? One-third of couples will discover fertility problems in only the woman. In cases of poor sperm quality, intrauterine insemination can be performed. This improves the chances that the embryo will implant at, or attach to, the wall of the uterus. In order to conceive, your sperm must be:  Highly concentrated — normally, there should be at least 15 million sperm in every ml of semen5  Moving well (motile) — a lashing tail helps your sperm to swim to your partner’s egg  Normally shaped — healthy sperm should be shaped like a streamlined tadpole  You may find that your semen contains a very low number of sperm (oligozoospermia), or no sperm at all (azoospermia). Allocation of medical resources that could be used elsewhere The legal status of embryos fertilized in vitro and not transferred in vivo. (See also beginning of pregnancy controversy). European Association of Urology guidelines on male infertility: the 2012 update. Microsurgery and Andrology. (PDF, 5 MB) Chapter from textbook, 1991.