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Infertility is the inability to conceive (reproduce) 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. In men, hormone disorders, chronic illnesses, reproductive anatomy trauma, genitourinary obstruction, or sexual dysfunction can temporarily or permanently affect the sperm and prevent conception. Some disorders become more difficult to resolve the longer they persist without treatment.
Sperm development (spermatogenesis) takes place in the seminiferous tubules (ducts) of the testes. Cell division produces spermatozoa (mature sperm cells) that contain one-half of a man’s genetic code. Each spermatogenesis cycle consists of six stages and takes about 16 days to complete. Approximately five cycles, or 2 ½ – 3 months, are needed to produce one mature sperm. Mitochondria (energy-generating organelles) inside each sperm power its tail (flagellum) so that it can swim to the female egg once inside the vagina. Sperm development is ultimately controlled by the endocrine (hormonal) system that comprises the hypothalamic-pituitary-gonadal axis.
Because sperm development takes about 3 months, illnesses that were present during the first cycle 3 months prior may today affect mature sperm, regardless of a man’s present health at the time of examination.
According to the National Institutes of Health, male infertility is involved in approximately 40% of the 2.6 million infertile married couples in the United States.
The primary causes of male infertility are problems with sperm production due to Varicocele (sperm delivery) related to obstruction. Other causes are:
The search for a cause of infertility usually begins with the male, because male examination and testing is less complicated. A thorough examination and a review of the man’s medical and surgical history are necessary, because chronic disease, pelvic injury, childhood illness, abdominal or reproductive organ surgery, recreational drug use, and medications can affect fertility. Physical examination may detect testicular irregularities (e.g., vericocele, absence of vas deferens, tumor), evidence of hormonal disorders (e.g., underdeveloped reproductive organs, enlarged breast tissue, or evidence of testosterone deficiency).