What is male infertility?

If you aren't able to get pregnant after a year of trying (or 6 months, if you're over 35), your doctor may suggest testing and treatment. But some people who have tried treatment without success become pregnant later without more treatment.

Sometimes infertility is related to lifestyle or other health conditions. To help protect your fertility:

• Avoid using tobacco (cigarettes) and marijuana.
• Avoid exposure to harmful chemicals.
• Avoid excessive alcohol use.
• Limit sex partners and use condoms to reduce the risk of getting a sexually transmitted infection (STI). Untreated STIs can damage the reproductive system and cause infertility. If you think you may have an STI, get treatment right away to reduce the risk of damage.
• Stay at a body weight that's close to the ideal for your height. It will reduce the chance of hormone imbalances.

If you have been diagnosed with cancer and hope to have children in the future, talk to your doctor about your options to help preserve fertility.

To check for infertility, a doctor can:

• Do a physical exam.
• Ask questions about your past health. This may help your doctor find clues, such as a history of miscarriages or pelvic inflammatory disease.
• Ask about your lifestyle habits. This includes how often you exercise and whether you drink alcohol or use drugs.
• Do tests that check semen quality. Other tests can measure hormone levels. Hormone imbalances can be a sign of ovulation problems or sperm problems that can be treated.
• Check the uterus, fallopian tubes, and ovaries.

Before you have fertility tests, it may help to try fertility awareness. Chart basal body temperature and use home tests to learn when you are likely to ovulate and be fertile. Some people find that they have been missing the most fertile days when trying to conceive.

Medicine or hormone treatments are often the first steps in fertility treatment. They're also used for in vitro fertilization (IVF) and other assisted reproductive technologies. Medicines include:

• Clomiphene and letrozole. These stimulate the release of hormones that help with ovulation.
• Gonadotropins. These hormone shots stimulate the ovaries to produce mature eggs.
• Treatment for polycystic ovary syndrome (PCOS). If you're not ovulating because of PCOS, your doctor might recommend a drug such as metformin along with clomiphene.
• Gonadotropin-releasing hormone (GnRH). It increases production of hormones needed to produce eggs and sperm.
• Bromocriptine and cabergoline. These lower prolactin levels. High prolactin levels can prevent ovulation and sperm production.
• GnRH analogue. This is used for IVF.

For some people with fertility problems, a structural problem can be treated with surgery. Treatment can increase the chances of natural conception.

When thinking about surgery, ask your doctor questions about the procedure. For example, how many times has the surgeon done the procedure? What are the chances of treatment success? How long will it take to recover?

Surgery may include:

• Fallopian tube procedures. This includes sterilization reversal.
• Laparoscopic surgery. This may help treat endometriosis.
• Myomectomy. This may help treat uterine fibroids.
• Laparoscopic ovarian drilling. This may be used when weight loss and medicine haven't stimulated ovulation in people who have polycystic ovary syndrome (PCOS).
• Varicocele repair. This is used to cut or bypass an enlarged vein in the scrotum.
• Vasectomy reversal. This reconnects the tubes (vas deferens) that were cut during a vasectomy.

If you have severely blocked fallopian tubes, your doctor may recommend that you skip surgery and have in vitro fertilization (IVF). You might also choose IVF first if you are older than 34 (for any type of blockage) or if you want to get pregnant as soon as possible, at any age. You may be able to get pregnant sooner if you choose IVF than if you have surgery.

Things that increase your risk for infertility include:

• Age. Eggs and sperm can decrease in number or quality with age.
• Birth defects. Some people were born with problems in their reproductive systems.
• Moderate or severe endometriosis.
• Past exposure to very high levels of environmental toxins, certain drugs, or high doses of radiation. This includes cancer chemotherapy or radiation.
• Past infection with a sexually transmitted infection (STI) that has since damaged the reproductive system. This includes gonorrhea or chlamydia.
• Polycystic ovary syndrome. This is a hormone imbalance that can affect ovulation. This can make it harder to get pregnant.

When you have infertility, you may feel alone, confused, or scared. Talking with others about your feelings can help. Here are some places you may find support.

• Family and friends. They can help you cope by giving you comfort and encouragement.
• Counseling. Professional counseling can help you understand and deal with your infertility, and the emotions that may come with it.
• Your doctor. Find a doctor you trust and feel comfortable with. Be open and honest about your fears and concerns.
• Spiritual or religious groups. These groups can provide comfort. And they may be able to help you find counseling or other social support services.
• Support groups. In a support group, you can talk to others who have had similar experiences. Your doctor may be able to tell you about groups in your community. You may also be able to find support in online groups, forums, or discussion boards.