SHOOTING BLANKS?

Infertility is the inability to conceive after at least one year of unprotected intercourse. Since most people are able to conceive within this time, physicians recommend that couples unable to do so be assessed for fertility problems (OB-GYN for females; Urologist for males).

In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they persist without treatment.

Infertility can result from a condition that is present at birth (congenital) or can develop later (acquired).

Listed below are common causes of infertility:

* Chemotherapy
* Defect or obstruction in the reproductive system (e.g., cryptorchidism, anorchia)
* Disease (e.g., cystic fibrosis, sickle cell anemia, sexually transmitted disease
[STD])
* Hormone dysfunction (caused by disorder in the hypothalamic-pituitary-gonadal
axis)
* Infection (e.g., prostatitis, epididymitis, orchitis)
* Injury (e.g., testicular trauma)
* Medications (e.g., to treat high blood pressure, arthritis)
* Metabolic disorders such as hemochromatosis (affects how the body uses and stores iron)
* Retrograde ejaculation (i.e., condition in which semen flows backwards into the
bladder during ejaculation)
* Systemic disease (e.g., high fever, infection, kidney disease)
* Testicular cancer
* Varicocele

A thorough examination and a review of the man's medical and surgical history are necessary, because chronic disease, pelvic injury, childhood illness, abdominal or reproductive organ surgery, recreational drug use, and medications can affect fertility. Physical examination may detect testicular irregularities (e.g., varicocele, absence of vas deferens, tumor), evidence of hormonal disorders (e.g., underdeveloped reproductive organs, enlarged breast tissue), or evidence of testosterone deficiency.

A semen analysis is done to examine the entire ejaculate, because seminal fluid can affect sperm function and movement. Generally, three semen samples are taken at different times to account for variables such as temperature and error.

Treatment options include the following:

* assisted reproduction
* medical treatment
* surgery