When to Test His Fertility

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What Treatment Options Are Available?

Certain infections, such as mumps contracted after puberty, have been shown to dramatically affect sperm counts. Others, such as the presence of white cells in the semen of a man who is otherwise asymptomatic, are less clear, but treatment is probably indicated and may result in some improvement. Chronic illnesses, such as diabetes, are important. Prior treatment for cancer by surgery, radiation, or chemotherapy can also be significant.

  • Heredity: Genetic causes may come from chromosomal abnormalities or to a defect (mutation) in a gene. There is a host of very uncommon to rare disorders caused by gene mutations that result in male infertility. The most common genetic reason for an absence of sperm in the semen is obstruction in the flow of sperm through the vas deferens on either side. This condition, called congenital bilateral absence of the vas deferens (CBAVD), is a primarily genital form of cystic fibrosis (CF). Men with this disorder have inherited two different, often uncommon or rarer CF gene mutations from either parent. These men manufacture normal sperm but have undeveloped vas and cannot deliver sperm.

  • Other causes: Obviously, a history of a prior vasectomy is important. There may be increased antibody production in men who have had a prior vasectomy and a reversal. The same may be true in individuals who have experienced significant injuries to the testicles.

  • Chronic stress: Can stress have a negative impact? Maybe! Long-term, high-stress situations can lead to a decrease in testosterone production, and possibly in sperm production.

    • There are ways to improve sperm counts, and we will detail those in the next few paragraphs. However, the treatment of male infertility and improvement of sperm counts has been a frustrating problem for both the patient and the physician for a long time.

    The process of creating sperm is an extremely complex one that occurs over the course of about 70 days. Our understanding of this remarkable process is rudimentary, at best, and our ability to define where a problem exists and to correct it is almost nonexistent. Until recently, we could do nothing for many cases. Now, however, with the advent of laboratory techniques such as IVF and ICSI, we have the ability to take the most compromised of sperm samples and achieve fertilization in the laboratory.

    Men with even just a few sperm can achieve pregnancy. The bottom line when it comes to treating male fertility is this: Much of the focus in the treatment of male infertility has shifted from trying to improve sperm production and quality to finding ways to work with whatever sperm are present.

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