as sauna or hot tub use, may affect sperm viability.
Such effects may be temporary or permanent.
Viral infections such as the MUMPSand bacterial
EPIDIDYMITISmay damage or destroy testicular tis-
sue. CHROMOSOMAL DISORDERSsuch as KLINEFELTER’S
SYNDROME and endocrine disorders may affect
TESTOSTERONE production. Congenital absence of
the VAS DEFERENS, which often occurs in men who
have CYSTIC FIBROSIS, prevents sperm from leaving
the TESTICLES.
MALE INFERTILITY FACTORSagricultural pesticide exposure ATHEROSCLEROSIS
CHEMOTHERAPY chronic ORCHITIS
chronic PROSTATITIS chronic URETHRITIS
cigarette smoking CRYPTORCHIDISM
CUSHING’S SYNDROME CYSTIC FIBROSIS
DIABETES DOWN SYNDROME
ERECTILE DYSFUNCTION excessive ALCOHOL
HYDROCELE consumption
HYPOGONADISM KLINEFELTER’S SYNDROME
low SEMENvolume low SPERMcount
low sperm motility malformed sperm
OBESITY prolonged elevated body
RADIATION THERAPY temperature
RETROGRADE EJACULATION SICKLE CELL DISEASE
SPERMATOCELE substance abuse
TESTICULAR CANCER testicular trauma
untreated EPISPADIAS untreatedHYPOSPADIAS
VARICOCELE viral or bacterial EPIDIDYMITIS
Combined factor infertility In combined factor
infertility the reason for infertility results from the
unique combination of factors each partner brings
to the couple. A third of infertility circumstances
arise from combined factors or remain unknown
in their origin. Combined factors may be elements
that, on their own, would not be sufficient to pre-
vent conception. In particular combinations, how-
ever, these elements result in infertility. The
woman’s IMMUNE SYSTEMmay generate antibodies
that attack the man’s sperm. Combined factor
infertility is often the most difficult to sort out and
treat.
Symptoms and Diagnostic PathThe primary symptom of infertility is the absence of
pregnancy after one year of unprotected SEXUAL
INTERCOURSEwhen pregnancy is the desired out-
come. The diagnostic path begins with comprehen-
sive medical examination, including PELVIC EXAMI-
NATIONfor women, and detailed history of attempts
to conceive. Further diagnostic procedures depend
on the preliminary findings and suspicions, though
typically include laboratory tests for STDs, BLOOD
tests for antibodies and HORMONE levels for the
woman, and semen analysis for the man.
Additional diagnostic procedures for the
woman may include- basal body temperature journaling over several
months to assess ovulation - pelvic or transvaginal ULTRASOUNDto examine
the OVARIESand reproductive organs - analysis of vaginal fluids to assess acidity (pH)
and mucus - hysterosalpingogram, a contrast medium X-RAY
examination of the uterus and fallopian tubes - karyotyping to detect chromosomal abnormali-
ties such as TURNER’S SYNDROME - exploratory laparoscopy to visually examine
the internal pelvic structures
Additional diagnostic procedures for the man
may include- blood tests to measure hormone levels
- scrotal ultrasound to detect HYDROCELE, VARICO-
CELE, orSPERMATOCELE - karyotyping to detect chromosomal abnormali-
ties such as Klinefelter’s syndrome
Treatment Options and Outlook
Treatment targets the identified or suspected
cause. Basic approaches include frequent sexual
intercourse, sexual positions that support concep-
tion, and timing sexual intercourse with ovula-
tion. These basic measures result in conception
within two years in about a third of couples.
Other straightforward solutions may include treat-
ment for infections or endocrine disorders (such as
previously undiagnosed HYPOTHYROIDISMor ADRENAL
INSUFFICIENCY).
Further treatment is more invasive. In men,
such treatment may consist of surgery to repair
hydrocele, varicocele, or spermatocele. Testos-
terone supplementation often improves sperm294 The Reproductive System