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Infertility and Men

Although some people still think of fertility as a "woman's problem," a third of all cases of infertilty involve problems solely with the male partner. Infertility in a man may be the sole reason that a couple can't conceive, or it may simply add to the difficulties caused by infertility in his partner.

So it's crucial that men get tested for fertility as well as women. It's also important that men do it early. Though some guys may want to put off being tested -- possibly to avoid embarrassment -- early testing can spare their partners a great deal of unnecessary discomfort and expense. It's also a good way to quickly narrow down potential problems.

Fertility Testing

Q. What goes into a fertility evaluation?
A. A standard fertility evaluation includes physical exams and medical and sexual histories of both partners. Men undergo a semen analysis that evaluates sperm count and sperm movement. "We look at the percent that are moving and how they are moving--are the sperm sluggish? Are they wandering?" says Robert G. Brzyski, M.D., Ph.D., associate professor of obstetrics and gynecology at the University of Texas Health Science Center at San Antonio. "Often, it's not possible to identify a specific reason for a sperm disorder," he says. "But there is new recognition that very low sperm or no sperm may be related to genetics--an abnormality of the Y chromosome."

For women, doctors first check to see whether ovulation is occurring. This can be determined and monitored through blood tests that detect hormones, ultrasound examinations of the ovaries, or an ovulation home test kit. "An irregular menstrual pattern would make us suspicious of an ovulation problem, but it's also possible for a woman with regular periods to have an ovulation disorder," Brzyski says.

Getting Tested for Infertility

The first thing to do for fertility issues is to go to the doctor, typically a urologist. After a physical exam, your doctor will probably order a semen analysis, which will check the quality and quantity of the sperm in the semen. And yes, your doctor will want you to give the sample there, or at least someplace nearby, because it's important that the analysis take place quickly. Just remember, as sheepish as you might feel, a semen analysis is a common test, and the results could save you months of worry and stress.

If the first semen analysis is normal, your doctor may order a second test to confirm the results. Two normal tests usually are interpreted to mean that the man doesn't have any significant infertility problems. If something in the results looks irregular, your doctor might order further tests to pinpoint the problem. At this point, if you aren't already seeing a urologist, you should considering seeing a specialist.

What a Semen Analysis Can Detect

  • Azoospermia. No sperm are produced, or the sperm aren't appearing in the semen.
  • Oligospermia. Few sperm are produced.
  • Problems with sperm motility. If sperm aren't moving normally, they are less likely to be capable of fertilizing an egg.
  • Problems with sperm morphology. Problems with the form and structure -- or morphology -- of the sperm may cause infertility.

But while these conditions may be the direct reason that you can't conceive, they themselves may be caused by an underlying medical condition. Your doctor will probably want to investigate the issue further by ordering blood and urine tests or other procedures.

Reasons for Male Infertility

There are a wide number of reasons for male infertility. Some are caused by physical problems that prevent the sperm from being ejaculated normally in semen. Others affect the quality and production of the sperm itself.

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