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About fifteen percent of couples are declared infertile. Half of the time, this is due to male infertility, while a third are due to female infertility and twenty percent of the time the cause is both man and woman or is unknown. This occurs if you have been infertile for at least a year of trying to get pregnant.

Normally, the hypothalamus releases gonadotropin releasing hormone to trigger the pituitary gland to release FSH and LH, hormones that act directly on the testes in men and on the ovaries in women. In men, this causes a release in testosterone and causes the testes to produce sperm. If any part of this axis is affected, sperm are not made in sufficient amounts.

Spermatogenesis or the making of sperm occurs in the testes. It results from primitive stem cells called spermatogonia; these divide to make more spermatogonia that grow up to become spermatocytes. The spermatocytes divide to give rise to sperm cells or spermatozoa. The sperm cell develops a tail as it matures, which gives it its mobility. It takes 74 days to make a sperm cell from a spermatogonia cell. It is all under the control of FSH and LH. They stimulate the testosterone production and FSH targets the Sertoli cells, important in sperm cell production. Sperm matures and is stored in the epididymis for later use. Secretions from the seminal vesicles and the prostate are important in the creation of semen that is healthy and allows for maximal sperm health and motility.

Diagnosis of male infertility involves taking a history that includes having a history of orchitis from mumps in the past. A history of Klinefelter's syndrome means that the individual is likely to be infertile. Exposure to environmental toxins can affect fertility and medication use, such as sulfasalazine and Macrodantin, can affect fertility. Previous bladder or testicular surgery can adversely affect a man's fertility. Diabetic neuropathy can cause retrograde ejaculation, which involves ejaculating into the bladder instead of out through the urethra. Hernia repair can damage the testicular blood supply and people with cystic fibrosis cannot have the thin semen necessary for normal fertility. Too much heat applied to the testes and scrotum can make spermatogenesis decreased. Men with kidney disease or sickle cell disease have abnormal reproduction.

The physical examination looks at the size of the epididymis and testes. The secondary sexual characteristics are looked at, including whether or not there is a receding hairline. A small penis or testes can indicate a low fertility situation. The testes should be about 4.5 centimeters long and 2.5 centimeters in width, with a volume of around 20 milliliters. The testes can be measured with a caliper. Doctors can look for gynecomastia or enlarged breasts in men who have feminization syndrome. Hormone metabolism can be affected by having an enlarged liver. Doctors also look for hypospadias or other penile anatomic change that can affect fertility.

Doctors can do a sperm sampling to see if the sperm are motile and if they are normal in appearance. Sperm can be sluggish or can be abnormal in appearance. Both problems strongly affect a man's fertility.

Causes of infertility can be from hypothalamic disease, such as isolated FSH or LH deficiency. There can be a gonadotropin deficiency directly from the hypothalamus. Hyperprolactinemia can cause a diminished fertility. Too much exogenous hormones (either male or female hormones) can adversely affect fertility. Kallmann's syndrome is an isolated gonadotropin (LH or FSH) deficiency that can be familial or sporadic. It affects one in 10,000 men and causes hypogonadism (small testes). Pituitary insufficiency can be caused by tumors, surgery, radiation or infarction of the pituitary gland. This can result in low LH or FSH levels. Elevated prolactin levels can cause an insufficient means of making sperm.

Testicular causes of infertility include Klinefelter's syndrome, which yields an XXY chromosome situation and a XYY syndrome can both cause infertility. Male Turner's syndrome, called Noonan syndrome, is related to infertility in males. These are all chromosomal abnormalities. Recreational drugs can cause abnormalities of sperm production.

The treatment of abnormal sperm production and male infertility can involve correcting the underlying factors. Some men benefit from delivering several batches of sperm that are washed and then used in an intrauterine fertilization or injected directly into an egg in a test tube procedure. The fertilized egg is then introduced into the uterus in an in vitro procedure.

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