Frequently Asked Questions
What health problems can cause male infertility?
Many health problems--from kidney disease to testicular cancer--can result in male infertility. "Whole-body" health problems and metabolic disorders, and ordinary fevers and infections can harm sperm growth. Diseases passed through sex can lead to blocks and scars in the reproductive tract.
Genetic health problems, such as cystic fibrosis, may result in no sperm. This may be because the vas deferens or seminal vesicles are not there. Many illnesses can cause infertility. It's important that you and your partner tell your family and personal health histories to your health care provider.
Can cigarette smoke affect sperm?
Yes. Research shows that routine smoking affects sperm in many ways. It causes sperm cells to be smaller and slower. It harms their DNA. Smoking can also affect the seminal fluid ejaculated with sperm.
Can using steroids for body building cause infertility?
Yes. Steroids taken by mouth or shot can cause your body to stop making the hormones needed to make sperm.
Do abnormal semen analyses or sperm lead to children with birth defects?
Not necessarily. For most couples seeking fertility treatment, the risk of conceiving a child with a birth defect is the same as for the general population. Some problems (chiefly genetic problems) that cause infertility may also cause a greater risk of conceiving a child with birth defects. So couples need thorough exams and advice before beginning some forms of ARTs.
What's the main thing I should know about male infertility?
Infertility is not your or your partner's fault. The American Society of Reproductive Medicine (ASRM) estimates that in about a third of infertility cases it is due to the male. Another third is the female.
In the last third of infertile couples, the problem is caused by either a combination of reasons, or, in 20 out of 100 cases, it can't be explained.
In men, few or no sperm is the biggest problem. In women, the common problems are ovulation problems and blocked tubes. But today, technology and surgical tools exist to address many of these problems.
What are assisted reproductive techniques (ARTs)?
ARTs are high-tech methods to join sperm and egg when sex can't do it. Your health care provider may suggest one or more ARTs if pregnancy doesn't happen even though sperm are in your semen.
If I have obstructive azoospermia, when should my partner and I consider sperm retrieval with an assisted reproductive technique (ART) rather than surgery?
Often, microsurgical correction removes the need for ART. However, if that is not successful, sperm can be removed from the testicle or epididymis and injected into the vagina using ICSI, even after surgery to fix the blockage. ICSI is used because the number of motile sperm is often small and they don't move as well.
There are many methods for retrieving sperm cells. The choice will be up to you and your urologist. Sperm retrieval can be done before or at the same time as your partner's egg retrieval and IVF.
Many reproductive centers like to use "fresh" sperm retrieved on the same day as egg retrieval. Others favor sperm harvested earlier and frozen. Sperm can be retrieved by needle aspiration or microsurgery.
If I have a varicocele, when should my partner and I consider an assisted reproductive technique (ART) rather than surgery?
If you and your partner both have fertility problems and she can't get pregnant naturally, then one of the ARTs may help rather than surgery. But the choice isn't always clear. You and your health care provider will want to consider:
- the female partner's age and ovarian function
- the chance that a varicocele repair won't definitely fix your fertility
- the fact that ART is needed for each try at pregnancy
- data showing that a varicocele repair may help IUI and IVF results
Varicocele repair should be preferred if you don't have ideal semen but your partner is fertile. On the other hand, IVF, with or without ICSI, should be the first choice when there's a special need for such methods to treat a woman's infertility.
Are there risks with IVF/ICSI?
Yes, some risks exist, mostly for women. Mild ovarian hyperstimulation occurs in up to 20 out of 100 women who have IVF. It is caused by the hormones used in IVF/ICSI. Most women with mild cases tolerate symptoms well. There is moderate hyperstimulation in 5 out of 100 women having IVF.
But severe hyperstimulation can cause high blood pressure, fluid build-up, sadness, weakness, and other symptoms. These symptoms need to be treated in the hospital. Only 1 out of 100 women having IVF suffer from severe hyperstimulation. This form can cause serious health problems.
Multiple births are also possible with IVF/ICSI. In the United States, after IVF there is a 30% to 35% risk for twins and 5% to 10% for triplets or more.
Are the pituitary tumors that cause low gonadotropin or raised prolactin levels malignant tumors (cancer)?
No. These are most often benign (not cancer) tumors in the pituitary gland. If the tumor is large enough, you should talk to a neurosurgeon about taking it out. The tumor is often taken out through the nose.
Should I try empiric hormonal therapy if I also have a varicocele?
In most cases, unproven empiric therapies shouldn't be tried until you've dealt with known causes that can be fixed. Varicocele is the leading cause of impaired sperm production in the United States. Repair should be considered before any empiric hormonal therapy.
In light of the harmful effects of oxidants on sperm function, should all infertile men take the antioxidant vitamin E?
Vitamin E is a safe, well-tolerated supplement. Studies show it lowers the risk of heart disease. Taking 400 IU twice daily is also a low-cost, effective way to treat any oxidants that may affect fertility. But this treatment doesn't replace careful study of other known infertility causes in men or women. It's not an automatic treatment for all men.