From a man's point of view, starting a family is easy. While women are on the job for nine months, men can often complete the task in a single evening. When it comes time to try for a pregnancy, they just naturally assume that it will happen. But among the couples who try unsuccessfully for months or even years to get pregnant, about half the time the problem lies either with both partners or with the man.
In the past, women nearly always took the blame when couples failed to conceive. Today we know that fertility is a two-person job. If a woman doesn't get pregnant after more than a year of trying, there's a 30 to 40 percent chance that her partner's fertility problem may play a role, according to a report in the Journal of Urology. Many men don't produce enough sperm, and the sperm they make may be too slow or oddly shaped. Without a few billion sleek, powerful swimmers working on a guy's behalf, fatherhood can be a difficult destination.
A treatable condition
Fortunately, male infertility is often temporary and treatable, says Larry Lipshultz, chief of the division of male reproductive medicine and surgery at Houston's Baylor College of Medicine. If a couple has trouble conceiving, both partners should be evaluated by a urologist or a reproductive endocrinologist who specializes in fertility problems, he says. Even men who've fathered children in the past should get a checkup, he says.
For the man, the search for answers will start with a semen analysis. Typically, a doctor will check at least two samples collected a month apart. If a man's samples contain large amounts of active, normal-looking sperm, chances are he's fertile. But if anything seems out of the ordinary, he'll need a thorough physical exam and lab work to get to the root of the problem.
Men may be reluctant to see a doctor for such a personal matter, but they have strong incentives to get help, Lipshultz says. For one thing, a doctor may find a solution for their infertility. At the other end of the spectrum -- and more rarely -- a doctor may determine that biological fatherhood will be impossible, a finding that could help a couple avoid years of frustration and costly fertility treatments. There's another reason to get help, Lipschultz says. In roughly 2 percent of all cases, male infertility is a symptom of a life-threatening disease such as testicular cancer. If a man ignores his fertility problems, he can lose more than a chance for fatherhood.
Most infertile men have reason for optimism. In a study described in Postgraduate Medicine, 76 percent of men who sought treatment for fertility problems had a potentially correctable condition. Among the men who underwent treatment, 32 percent fathered a child without any other medical help, and another 43 percent showed improvement in the number or quality of their sperm.
Blockages in various parts of the sperm pathway are a common, treatable cause of male infertility. These blockages often occur as a result of infections, including the sexually transmitted diseases chlamydia and gonorrhea. In many cases, surgery can remove the obstruction and get the sperm back on their way. Another form of obstruction is "congenital absence of the vas deferens," common in men who have cystic fibrosis. Other potentially treatable causes of infertility include hormone imbalances, inflammation in the urinary system (including prostatitis and urethritis), and retrograde ejaculation, a condition in which semen flows into the bladder.
Some experts say that varicose veins or "varicoceles," in the testicles can lead to male infertility. As reported in Postgraduate Medicine, these twisted, enlarged veins may hamper sperm production, and the effect tends to get worse over time. "The sooner these can be diagnosed and treated, the better the results," Lipshultz says. A number of doctors assert that surgical repair of the vessels can improve sperm counts and boost the odds of pregnancy, but others say the link between varicoceles and infertility isn't firmly established.
Sometimes a man's hobbies can interfere with infertility. According to a small study conducted in Austria, frequent mountain biking may contribute to a man's infertility. The study looked at 55 avid mountain bikers and found that nearly 90 percent had low sperm counts and abnormalities in their scrotums. In contrast, only 26 percent of 35 non-bike riders had similar damage.
The study, presented at an annual meeting of the Radiological Society of North America, suggests that the frequent jolts and vibration associated with riding over rough terrain may be to blame. Infertility problems were most common in frequent bike riders who rode about 60 miles a week.
If there's no clear physical explanation for infertility, it's time to take a close look at what a man puts in his body. As reported in Postgraduate Medicine, some common prescription drugs can hamper sperm production. It's important to tell your doctor all the drugs you've been taking. The list of potential culprits includes the heartburn medication cimetidine (Tagamet), the rheumatoid arthritis drug sulfasalazine (Azulfidine), and several chemotherapy drugs. In some cases, a change in a prescription can restore fertility. Likewise, a man may be able to give his sperm a boost by avoiding cigarettes and going easy on alcohol. Heavy drinking can lead to a decrease in sperm count and movement, and smoking harms sperm's motility (ability to move). He should also stay away from recreational drugs such as marijuana, cocaine, and performance-enhancing drugs such as anabolic steroids.
Stress, obesity, malnutrition, radiation, major surgery, and overexposure to heat, chemicals, and poisons in the environment may also affect fertility. Pesticides with effects similar to those of estrogen have been linked strongly to a drop in sperm production, as has the insecticide DBCP.
If a man tells friends and relatives about his fertility troubles, it often unleashes an avalanche of advice -- some good, some bad. Almost invariably, someone will tell him he needs to wear loose pants and boxer shorts. This common belief is still being debated in the medical community, as studies on the impact of tight-fitting underwear on scrotal temperature are contradictory. Someone else might suggest an herbal "fertility" remedy. There's no evidence that these will take a man any closer to fatherhood, according to a report from the University of Iowa -- and worse, some herbal remedies could be harmful. Since herbs aren't tested for safety and efficacy, as prescription drugs are, men should talk with their doctors before experimenting with any supplement.
Some pieces of common wisdom actually turn out to be true. According to a report from the Mayo Clinic, a man trying to start a family really should stay clear of hot tubs or saunas: The sperm factories in the testicles don't work well under high temperatures. A Stony Brook University Hospital study found that men may also be feeling the heat from another direction -- laptop computers. Researchers found that holding a laptop computer on a man's lap for only an hour raised his testes temperature by 4.9 degrees Fahrenheit, which might be enough to impair fertility. Further research is needed to confirm the findings, say researchers.
Even if a man takes all the right steps and gets the best treatment possible, he may still be unable to father a child the "old-fashioned" way. But as long as he produces at least a few healthy sperm, there's still hope.
In a procedure known as intracytoplasmic sperm injection (ICSI), doctors collect a single sperm and inject it directly into a woman's egg in a laboratory dish. After fertilization, the embryo is implanted in the woman's uterus. According to the CDC, about 32 percent of ICSI procedures resulted in live births in 2007. In women under 35, pregnancy rates can be 60 percent or higher. Unfortunately, one cycle of ICSI costs from $10,000 to $20,000 -- a high price for a procedure with no guarantees.
After consulting with doctors and, more importantly, with each other, many couples decide not to try such measures. They may turn to a sperm bank or an adoption agency, or decide on a life without children. Some feelings of disappointment are inevitable, but at least they can get off the emotional roller-coaster they experienced month after month.
As easy as it seems, fatherhood isn't for everyone. It only comes to men who are either naturally fertile or willing to take action. A growing number of men are finding the courage to make that first call to the doctor. Their spouses are grateful -- and their children will be too.
Interview with Larry Lipshultz, MD, chief of the division of male reproductive medicine and surgery at Houston's Baylor College of Medicine.
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Jarring Result, Extreme biking can hurt men's fertility, by Nathan Seppa, Science News Dec. 7, 2002; Vol. 162, No. 23
Sheynkin Y, et al. Increase in scrotal temperature in laptop computer users. Human Reproduction. Dec 9, 2004.
American Society for Reproductive Medicine. FAQs About Infertility.
Mayo Clinic. Low Sperm Count. June 2010.
Mayo Clinic. Male Infertility. June 2010.
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