Every baby is a miracle. For some couples, the miracle happens quickly. For other couples, having a baby is a difficult and stressful process.
For couples that are trying to conceive for the first time, about half will conceive within three months (without using birth control). By six months, 75% of couples will conceive and, by one year, 85% will become pregnant.
That leaves 15% of couples that are unable to conceive after one year. After one year of trying, a couple may wish to consider seeking medical help to determine if one—or both—of them may be infertile.
When trying to find the cause for infertility, it’s important to consider the couple as a unit until the problem is uncovered. Testing to determine the cause of infertility usually starts with simple tests for both partners. In addition to obtaining histories and conducting physical examinations, initial tests will check semen quality and both partners’ hormone levels in the blood. (Hormone imbalances can be a sign of ovulation or sperm production problems that can be treated.) Depending on what is learned, the man or woman may be referred to a physician who specializes in male or female infertility treatment and reproductive endocrinology.
While 50% of all couples’ infertility can be attributed to female reproductive problems, about 30% is caused by problems in the male reproductive tract. In 20% of cases, both partners have problems that contribute to their infertility.
Diagnosing Male Infertility
If the problem appears to be with the man, there are many possible causes of male infertility. The most common cause is low or no sperm count. (About 10% to 15% of infertile men actually have no sperm in their semen.) A low sperm count may be the result of a genetic (chromosomal) disorder; a structural abnormality; infection; testicular injury or failure (present at birth or associated with chemotherapy or radiation); exposure to certain chemicals or drugs; a vascular problem, or a hormonal disorder in the testicles or pituitary gland. Although a man’s sperm count decreases with age, male fertility does not appear to be greatly affected by age.
About one-third of low sperm counts are due to vascular problems, such as a varicocele, which is a dilated (varicose) vein in the scrotum. In about 20% to 25% of cases, an exact cause for infertility cannot be determined.
Treatment to maximize a man’s fertility potential depends on the cause, if the cause has been identified. Some problems have more effective treatments than others.
Medication or hormone treatments are often the first steps in infertility treatment. They are typically less expensive and less risky than invasive procedures, and are used to increase sperm counts in men with abnormal hormone levels.
Microsurgery can be used to reverse a vasectomy, correct a blockage of the reproductive tract, or correct a varicocele in the scrotum.
Some couples that are unable to become pregnant in a natural way may turn to assisted methods of reproduction such as intrauterine insemination (flushing sperm into the woman’s uterus when she is ovulating) or in vitro fertilization (bringing eggs and sperm together for fertilization in a glass laboratory dish). Another method called intracytoplasmic sperm injection is used to enhance the fertilization phase of in vitro fertilization by injecting a single sperm into a mature egg. The fertilized egg is then placed in the woman’s uterus or fallopian tube. These methods may work for some couples; however, not all couples wish to or are able to pursue them.
The good news is that many causes of infertility can be treated successfully, and there is hope for many couples who find it difficult to conceive.