Erectile dysfunction, also called impotence, is the repeated inability to achieve or maintain a firm erection that lasts long enough for sexual intercourse. In most cases, men have erection problems .
United States of America (Press Release) April 8, 2008 --
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Male infertility is a broad and complex area. The following information is intended only as a very general introduction to the subject of male fertility and infertility. We strongly encourage you to find a specialist in your area to fully evaluate your particular situation. There are a variety of male infertility treatments to help a couple reach their goals.
Likelihood of Occurrence A male factor is involved in 60% of cases of couples' infertility. Forty percent are primarily male and 20% are combined male and female. Thus, when a couple is having trouble conceiving, it makes sense not only to evaluate the woman but to evaluate the man as well.
Sperm takes 3 months to produce and mature and there is often a 4 to 6 month delay between treatment of the man and resulting changes in the sperm. Since the evaluation of the woman may take several months, it is recommended that a comprehensive and accurate semen analysis be scheduled at the outset in order to evaluate the male partner. Treatment of the man can then occur at the same time as treatment of the woman and there will be no additional delay once the woman's treatment is completed.
Causes Varicoceles
Varicoceles are dilated veins in the scrotum (similar to varicose veins in the legs). These veins are dilated because the blood does not drain properly from them. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on sperm production. This condition is the most common reversible cause of male factor infertility and may be corrected by minor outpatient surgery.
Most experts perform this surgery microscopically to preserve the arterial supply and lymphatics. A sub-inguinal incision (about one inch above the penis and one inch from the midline) is usually used, as this avoids incising the abdominal muscles and creates less post-operative pain.
Seminal Fluid Abnormalities
If the seminal fluid is very thick, it may be difficult for the sperm to move through it and into the woman's reproductive tract. Often, the semen can be processed to separate the moving sperm from the surrounding debris, dead sperm, and seminal fluid. The processed sperm is usually placed directly inside the uterus with a small tube. This is called intrauterine insemination (IUI).
Ductal System Problems
Sperm carrying ducts may be missing or blocked. A patient may have bilateral (both sides) congenital (from birth) absence of the vas deferens. He may have obstructions either at the level of the epididymis (the delicate tubular structure draining the testes) or higher up in the more muscular vas deferens. He may have become mechanically blocked during hernia or hydrocele repairs. He may have become blocked by scar tissue as a response to an infection.
Sperm are stored in sacs called the seminal vesicles and are then deposited in the urethra, which is the tube through which men urinate and ejaculate. The sperm must pass through the ejaculatory ducts to get from the seminal vesicles to the urethra. If these are blocked on both sides, no sperm will come through.
In some situations, the ducts may be repaired or unblocked to allow them to flow through the man's reproductive tract. If this is not possible, the sperm may be harvested to allow them to flow through the man's reproductive tract. Because they are obtained in lower numbers, this procedure must be used in conjunction with advanced reproductive techniques to attempt a pregnancy.
Immunological Infertility
Men can develop an immunological response (antibodies) to their own sperm. The causes for this may include testicular trauma, testicular infection, large varicoceles, or testicular surgery. Sometimes, there are unexplained reasons for this occurrence.
These antibodies have a negative effect on fertility although the exact reason why this is the case is unclear. Most likely, these antibodies act negatively at several points along the pathway to fertilization. They make it more difficult for the sperm to penetrate the partner's cervical mucous and make its way into the uterus. They make it more difficult for the sperm to bind with the zonapellucida (the external membrane or shell of the egg). Also, the antibodies make it more difficult for the sperm to fuse with the membrane of the oocytes (eggs) themselves.
The treatment for anti-sperm antibodies is somewhat controversial. Men may be treated with corticosteroids. However, this can lead to significant morbidity in the man. The most significant is aseptic necrosis of the hip (noninfectious destruction of the joint), requiring hip replacement.
Most of the time, the first level of intervention includes intrauterine insemination. If the couple is planning in-vitro fertilization (IVF), the presence of anti-sperm antibodies is usually an indication to inject the sperm directly into the egg (ICSI) instead of conventional IVF.
Difficulties with Erections and Ejaculations
About five percent of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse, and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Many men will have difficulty with erections under the pressure of trying to achieve conception. These couples can easily learn the technique of self-insemination. Studies have shown that five out of six previously fertile couples having intercourse four times per week will conceive over six months, while only one out of six with intercourse once per week during the same period will conceive.
Testicular Failure
This generally refers to the inability of the sperm-producing part of the testicles (the seminiferous elithelium) to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons. The testicle may completely lack the cells that divide to become sperm (Sertoli Cell-Only Syndrome). There may be an inability of the sperm to complete their development (maturation arrest). Sperm may be made in such low numbers that few, if any, successfully travel through the ducts and into the ejaculated fluid (hypospermatogeneses). This situation may be caused by genetic abnormalities, hormonal factors, or varicoceles.
Even in the case where the testes are only producing low numbers of sperm, the sperm may be harvested and used in conjunction with advanced reproductive techniques to attempt a pregnancy.
Cryptorchidism
Cryptochiridism may be a cause of testicular failure. When a baby boy is born without the testes having fully descended into the scrotum, the condition is known as cryptorchidism.
Since the testes are very sensitive to temperature, if they do not descend into the scrotum prior to adolescence, they will stop producing sperm altogether. In fact, they have a higher rate of malignancy. The current recommendation is that at approximately one year of age, if the testes have not descended by themselves, they be brought down surgically.
Cryptorchidism is often associated with male factor infertility. Eight-one percent of men who have a single testis that is cryptorchid have normal fertility. However, approximately, 50% of men who have bilateral cryptorchidism have normal fertility. This may be due both to something inherent in the testes, to the surgery, or to damage done by not having the testes brought down in time.
and we are ready to take your orders!
Male infertility is a broad and complex area. The following information is intended only as a very general introduction to the subject of male fertility and infertility. We strongly encourage you to find a specialist in your area to fully evaluate your particular situation. There are a variety of male infertility treatments to help a couple reach their goals.
Likelihood of Occurrence A male factor is involved in 60% of cases of couples' infertility. Forty percent are primarily male and 20% are combined male and female. Thus, when a couple is having trouble conceiving, it makes sense not only to evaluate the woman but to evaluate the man as well.
Sperm takes 3 months to produce and mature and there is often a 4 to 6 month delay between treatment of the man and resulting changes in the sperm. Since the evaluation of the woman may take several months, it is recommended that a comprehensive and accurate semen analysis be scheduled at the outset in order to evaluate the male partner. Treatment of the man can then occur at the same time as treatment of the woman and there will be no additional delay once the woman's treatment is completed.
Causes Varicoceles
Varicoceles are dilated veins in the scrotum (similar to varicose veins in the legs). These veins are dilated because the blood does not drain properly from them. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on sperm production. This condition is the most common reversible cause of male factor infertility and may be corrected by minor outpatient surgery.
Most experts perform this surgery microscopically to preserve the arterial supply and lymphatics. A sub-inguinal incision (about one inch above the penis and one inch from the midline) is usually used, as this avoids incising the abdominal muscles and creates less post-operative pain.
Seminal Fluid Abnormalities
If the seminal fluid is very thick, it may be difficult for the sperm to move through it and into the woman's reproductive tract. Often, the semen can be processed to separate the moving sperm from the surrounding debris, dead sperm, and seminal fluid. The processed sperm is usually placed directly inside the uterus with a small tube. This is called intrauterine insemination (IUI).
Ductal System Problems
Sperm carrying ducts may be missing or blocked. A patient may have bilateral (both sides) congenital (from birth) absence of the vas deferens. He may have obstructions either at the level of the epididymis (the delicate tubular structure draining the testes) or higher up in the more muscular vas deferens. He may have become mechanically blocked during hernia or hydrocele repairs. He may have become blocked by scar tissue as a response to an infection.
Sperm are stored in sacs called the seminal vesicles and are then deposited in the urethra, which is the tube through which men urinate and ejaculate. The sperm must pass through the ejaculatory ducts to get from the seminal vesicles to the urethra. If these are blocked on both sides, no sperm will come through.
In some situations, the ducts may be repaired or unblocked to allow them to flow through the man's reproductive tract. If this is not possible, the sperm may be harvested to allow them to flow through the man's reproductive tract. Because they are obtained in lower numbers, this procedure must be used in conjunction with advanced reproductive techniques to attempt a pregnancy.
Immunological Infertility
Men can develop an immunological response (antibodies) to their own sperm. The causes for this may include testicular trauma, testicular infection, large varicoceles, or testicular surgery. Sometimes, there are unexplained reasons for this occurrence.
These antibodies have a negative effect on fertility although the exact reason why this is the case is unclear. Most likely, these antibodies act negatively at several points along the pathway to fertilization. They make it more difficult for the sperm to penetrate the partner's cervical mucous and make its way into the uterus. They make it more difficult for the sperm to bind with the zonapellucida (the external membrane or shell of the egg). Also, the antibodies make it more difficult for the sperm to fuse with the membrane of the oocytes (eggs) themselves.
The treatment for anti-sperm antibodies is somewhat controversial. Men may be treated with corticosteroids. However, this can lead to significant morbidity in the man. The most significant is aseptic necrosis of the hip (noninfectious destruction of the joint), requiring hip replacement.
Most of the time, the first level of intervention includes intrauterine insemination. If the couple is planning in-vitro fertilization (IVF), the presence of anti-sperm antibodies is usually an indication to inject the sperm directly into the egg (ICSI) instead of conventional IVF.
Difficulties with Erections and Ejaculations
About five percent of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse, and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Many men will have difficulty with erections under the pressure of trying to achieve conception. These couples can easily learn the technique of self-insemination. Studies have shown that five out of six previously fertile couples having intercourse four times per week will conceive over six months, while only one out of six with intercourse once per week during the same period will conceive.
Testicular Failure
This generally refers to the inability of the sperm-producing part of the testicles (the seminiferous elithelium) to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons. The testicle may completely lack the cells that divide to become sperm (Sertoli Cell-Only Syndrome). There may be an inability of the sperm to complete their development (maturation arrest). Sperm may be made in such low numbers that few, if any, successfully travel through the ducts and into the ejaculated fluid (hypospermatogeneses). This situation may be caused by genetic abnormalities, hormonal factors, or varicoceles.
Even in the case where the testes are only producing low numbers of sperm, the sperm may be harvested and used in conjunction with advanced reproductive techniques to attempt a pregnancy.
Cryptorchidism
Cryptochiridism may be a cause of testicular failure. When a baby boy is born without the testes having fully descended into the scrotum, the condition is known as cryptorchidism.
Since the testes are very sensitive to temperature, if they do not descend into the scrotum prior to adolescence, they will stop producing sperm altogether. In fact, they have a higher rate of malignancy. The current recommendation is that at approximately one year of age, if the testes have not descended by themselves, they be brought down surgically.
Cryptorchidism is often associated with male factor infertility. Eight-one percent of men who have a single testis that is cryptorchid have normal fertility. However, approximately, 50% of men who have bilateral cryptorchidism have normal fertility. This may be due both to something inherent in the testes, to the surgery, or to damage done by not having the testes brought down in time.
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