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Male Fertility


Causes

There are many reasons for male infertility which include:

Hormonal Disorders

Infertility can result from disorders of the testicles themselves, or an abnormality affecting the pituitary and hypothalamus glands in the brain that produce hormones that control the testicles (the hypothalamus or pituitary glands).

Genetic & Familial Disorders

Genetic disorders of the testes such as Klinefelter's syndrome (male is born with two X and one Y chromosome instead of one X and one Y), microdeletion of chromosomes amongst many others cause abnormal development of the testicles.

Injury

  • Direct: Testicular or Pelvic Trauma
  • Indirect: Heat, Radiation, Radiotherapy, Chemotherapy, Environmental Toxins, Smoking, Drugs, Marijuana, Tobacco, Alcohol, blockage in the ejaculatory duct.

Previous Surgery

Inguinal, Scrotal, Retroperitoneal, Bladder Neck, Vasectomy, Hydrocele.

Varicocele

In this, veins of the scrotum get enlarged and tortuous, much like varicose veins in the legs, a problem that many of us are familiar with.

Undescended Testes

Physiologically, it is important for testes to have a temperature that is a few degrees lower than body core temperature in order for sperm production to occur normally. This is why nature has placed the testes outside the body - the higher internal core body temperature is deleterious to sperm production. This also explains why many men with undescended testes are infertile.

Sexual Issues

Often treatable, problems with sexual intercourse or technique may affect fertility. Difficulties with erection of the penis (erectile dysfunction), premature ejaculation, painful intercourse (dyspareunia), or psychological or relationship problems can contribute to infertility.

Retrograde Ejaculation

This occurs when semen enters the bladder during ejaculation rather than emerging out through the penis. Various conditions can cause retrograde ejaculation, including diabetes, bladder, prostate or urethral surgery, certain neurological diseases and the use of certain medications.

Misplaced Urinary Opening (Hypospadias)

A birth defect can cause the urinary (urethral) opening to be abnormally located on the underside of the penis. If not surgically corrected, this condition can prevent sperm from reaching the woman's cervix.

Infections

Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, are most often associated with male infertility. These infections can cause scarring and block sperm passage. If mumps (viral infection usually affecting young children) occurs after puberty inflammation of the testicles can impair sperm production. Inflammation of the prostate (prostatitis), urethra or epididymis also may alter sperm motility and block the passage. Post surgery of bladder, urethra and prostrate and affect sperm production.

Abnormal/low Sperm Count

Lifestyle issues: Alcohol and drugs, Tobacco smoking, Emotional stress

Alcohol or drug dependency can cause reduced fertility. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Men who smoke may have a lower sperm count than do those who don't smoke. Passive smoking may affect male fertility. Stress may interfere with certain hormones needed to produce sperm.

Environmental Issues (exposure to toxins, heavy metals, excessive heat, etc.)

Certain Prescription Medicines

Medical conditions

Various medical conditions that can cause infertility include Diabetes, Pituitary gland disease, Hypothalamus disorder, Multiple sclerosis, Cushing's syndrome, Hypogonadism.

Idiopathic (cause not known)

Evaluation

Some infertile couples have more than one cause of their infertility. In some cases, the cause of infertility may be unclear, or it may take a number of tests to determine the cause.

For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina.

Tests for male infertility attempt to determine whether any of these processes are impaired. They include:

Medical History

This includes questions about illnesses, disabilities and surgeries that could affect fertility. Medications and sexual habits are also evaluated. Sexual development as a boy and whether one has had any signs of low testosterone such as decreased body or facial hair and development of breast etc. are also looked for.

General Physical Examination

Semen Analysis

This is the gold standard for diagnosis of male infertility. Physical characteristics of semen, the number of sperm present, any abnormalities in the shape and structure (morphology) and movement (motility) of the sperm are evaluated. The lab will also check your semen for signs of problems, such as infections or blood. Often sperm counts fluctuate from one specimen to the next, so your doctor may want to evaluate fertilizing potential with few different samples. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting further male infertility tests.

Depending on initial findings, the doctor may recommend additional, more specialised tests that can help identify the cause of infertility.

Scrotal Ultrasound

Ultrasound, which uses high-frequency sound waves to produce images of structures within your body, can help your doctor look for evidence of a varicocele or obstruction of the epididymis.

Hormone Testing

Hormones produced by the hypothalamus and pituitary glands and the testicles play a key role in sexual development and sperm production. Your doctor may recommend a blood test to determine the level of testosterone and other male hormones that affect fertility.

Genetic Tests

These tests are used if your doctor suspects your fertility problems could be caused by an inherited sex chromosome abnormality. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome.

Testicular Biopsy

This test involves removing samples from the testicle with a needle. It may be used if semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal.

Anti-sperm Antibody Tests

These tests are used to check for immune cells (antibodies) that attack sperm and can affect their ability to function.

Vasography

In some cases, contrast dye is injected into each vas deferens to see if they are blocked.

Specialised sperm Function Tests

A number of different tests can be used to evaluate how well sperm survive after ejaculation, how well they can penetrate the egg membrane, and whether there's any problem attaching to the egg.