Infertility is the inability to conceive a child after one year of unprotected sexual intercourse. Female infertility is usually treated by a physician trained in obstetrics and gynecology. Male infertility is usually treated by a urologist. Some of the causes of male infertility include varicocele (a cluster of dilated veins that drain the blood leaving the testicles), previous vasectomy, retrograde ejaculation (when the ejaculate travels into the bladder instead of into the urethra) which may be a complication of diabetes, spinal cord injury,or surgery. Other causes may be a past history of undescended testes, hormone imbalance, illnesses, medications, drug abuse, blockage of sperm ducts, or genetic abnormalities such as cystic fibrosis.
In first evaluating a couple with infertility, the urologist will interview the man to determine any possible causes, a physical exam will be performed, and a sperm count may be ordered. Additionally, blood tests to measure the patient's hormones may be ordered. If a varicocele is the suspected cause, the physician may perform a number of tests including an ultrasound, which measures the flow of blood into and out of the veins of the testicle.
- If the cause of infertility is a previous vasectomy, it is corrected by surgery. Post-operatively, semen will be checked for sperm. Vasectomy reversal techniques are successful in about 90% of cases; however, the chance of having live sperm and achieving pregnancy is related to the length of time that has passed since the vasectomy.
- If a varicocele is the cause of infertility, surgery is performed to remove dilated veins in the testicle.
- If retrograde ejaculation is the cause of infertility, the sperm in the first urination following ejaculation is collected and then implanted in the uterus of the female.
- If a hormonal imbalance causes infertility, the exact cause of the hormonal imbalance must be determined in order effectively treat the patient.
- Sperm may need to be harvested directly from the testes to be used with invitro fertilization techniques.
Many causes of infertility are reversible, but it may take months or even years for fertility to return. If the cause of infertility is that the testicle is not producing sperm, the patient should be allowed to pursue other options, such as adoption.