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Male Infertility

Causes of Male Infertility

Infertility in Males is mostly due to either poor sperm quality, less number of sperms or both. Some other factors which may influence are hormonal imbalances, genetic disorders or structural defects.

Sperm Abnormalities

The major abnormality which plays an important role in male infertility is the sperm abnormality. These abnormalities include:
Sperm abnormalities are categorized by whether they affect sperm count, sperm movement, or sperm shape. They include:

• Oligospermia .
• Azoospermia
• Asthenospermia.
• Teratospermia

Retrograde Ejaculation

Retrograde ejaculation occurs when the muscles of the bladder wall do not function properly during orgasm and sperm are forced backward into the bladder instead of forward out of the urethra. Sperm quality is often impaired.

Hormonal Deficiencies

Infertility may be due to hypogonadism, usually present at the time of birth, affecting pituitary gland which includes Kallman syndrome, panhypopituitarism or deficiencies to FSH and LH hormones. However hypogonadism may occur later in life either due to radiations exposure, chemotherapy, or brain tumor.

Genetic Disorders

There may be certain genetic disorders which can cause infertility, such as;:
• Polycystic kidney disease,
• Klinefelter syndrome
• Kartagener syndrome

Anatomical Defect

Any anatomical defect which affects the normal function of reproductive organs can cause fertility:

• Cryptorchidism. Condition in which newborn infants testicles failed to descend from the abdomen into the scrotum.
• Hypospadias. Hypospadias is a birth defect in which the urethral opening is on the underside of the penis which may hinder sperm from reaching the cervix if not surgically correct.
• Blockage in the epididymis or ejaculatory Tubes.

Risk Factors

• Varicocele; Varicocele may increase the temperature of testis affecting the sperm production , shape and movement.
• Age ; As a person ages, there is also gradual decrease in quantity and quality of male sperm.
• Sexually Transmitted Diseases. ; Many STDs impair sperm function such as gonorrhea or Chlamydia infections may cause scarring and block sperm passage.
• Repeated Chlamydia trachomatis or gonorrhea infections are the sexually transmitted diseases most often associated with male infertility. Such infections can cause scarring and block sperm passage. Human papilloma viruses, the cause of genital warts, may also impair sperm function.

Lifestyle Factors

The normal sperm production can be impaired by mental or physical injury. However some other factors which make effect the normal sperm production are smoking, obesity, bicycling, prolonged hot bath, drug and steroids abuse.

However chronic exposure to toxic chemicals, radiations, environmental pollution may also affect male fertility.

Diagnosis

Diagnosis can be done by taking proper fertility history and by physical examination. The physical examination includes, presence of varicocele, size of testis, scrotal thermography, and hypospadias. Post ejaculatory urine sample can help out to test for infections. The semen analysis is carried out to know about volume, concentration, count, motility and morphology of sperms.

Ultrasound

Ultrasound imaging may be used to accurately determine the size of the testes or to detect cysts, tumors, abnormal blood flow, or varicoceles that are too small for physical detection (although such small veins may have little or no effect on fertility). It can also help detect testicular cancer.

Therapy

As a lot of factors may affect the male fertility.  Surgery surgery is required in case of varicoleles. Drug therapy is used for treating hypogonadism or other hormonally related problems.

The alternate techniques are;

  • Intrauterine insemination
  • Testicular Fine Needle Aspiration
  • Microsurgical Epididymal Sperm Aspiration.
  • Percutaneous Epididymal Sperm Aspiration
  • Testicular Sperm Extraction.
  • Testicular Sperm Aspiration
  • Intrauterine Insemination (Artificial Insemination)
  • Intracytoplasmic Sperm Injection (ICSI)

 

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