Encyclopedia of Health and Medicine

294 The Reproductive System
as sauna or hot tub use, may affect sperm viability.
Such effects may be temporary or permanent.
Viral infections such as the MUMPS and bacterial
EPIDIDYMITIS may damage or destroy testicular tissue.
CHROMOSOMAL DISORDERS such 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 FACTORS
agricultural pesticide exposure ATHEROSCLEROSIS
CHEMOTHERAPY
chronic ORCHITIS
chronic PROSTATITIS
chronic URETHRITIS
cigarette smoking
CRYPTORCHIDISM
CUSHING’S SYNDROME
CYSTIC FIBROSIS
DIABETES
ERECTILE DYSFUNCTION
HYDROCELE
HYPOGONADISM
low SEMEN volume
low sperm motility
OBESITY
RADIATION THERAPY
RETROGRADE EJACULATION
SPERMATOCELE
TESTICULAR CANCER
untreated EPISPADIAS
VARICOCELE
DOWN SYNDROME
excessive ALCOHOL
consumption
KLINEFELTER’S SYNDROME
low SPERM count
malformed sperm
prolonged elevated body
temperature
SICKLE CELL DISEASE
substance abuse
testicular trauma
untreated HYPOSPADIAS
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 prevent
conception. In particular combinations, however,
these elements result in infertility. The
woman’s IMMUNE SYSTEM may generate antibodies
that attack the man’s sperm. Combined factor
infertility is often the most difficult to sort out and
treat.
Symptoms and Diagnostic Path
The primary symptom of infertility is the absence of
pregnancy after one year of unprotected SEXUAL
INTERCOURSE when pregnancy is the desired outcome.
The diagnostic path begins with comprehensive
medical examination, including PELVIC EXAMI-
NATION for 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 ULTRASOUND to examine
the OVARIES and 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 abnormalities
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, or SPERMATOCELE
• karyotyping to detect chromosomal abnormalities
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 conception,
and timing sexual intercourse with ovulation.
These basic measures result in conception
within two years in about a third of couples.
Other straightforward solutions may include treatment
for infections or endocrine disorders (such as
previously undiagnosed HYPOTHYROIDISM or ADRENAL
INSUFFICIENCY).
Further treatment is more invasive. In men,
such treatment may consist of surgery to repair
hydrocele, varicocele, or spermatocele. Testosterone
supplementation often improves sperm