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Male infertility

Male infertility –Causes, Diagnosis and its Treatment

 

Introduction

Male infertility is a situation where a couple is unable to conceive due to factors attributable to the male partner. About one-third of cases of infertility are caused by the male alone while in some cases, the infertility can be attributed to a combination of male and female factors.

 

Causes

Male infertility can be the result of several factors. For conception to take place, the males must produce healthy sperm which in turn requires that the male reproductive organs have formed during puberty. It is also important for the body to produce required hormones that facilitate production of sperm. After production of sperm, they are mixed with semen and ejaculated out of the penis. The number of sperm in the semen (sperm count) should be fairly high to increase chances of fertilization. Sperm movement and function should be normal and any abnormality can impede chances of sperm reaching the partner’s egg. A problem at any stage of the above process can lead to an inability to fertilize the partner’s egg.

 

Medical causes of male infertility include varicocele which is enlargement of the veins that drain blood from the testicle. This may lead to reduced sperm count and motility. Reduced sperm count may also be the result of an infection like chlamydia, gonorrhea, mumps, or inflammation of the prostate. Damage in the sperm duct because of genetic factors or scarring from infection could lead to inability to transport sperm from the testicles to the penis. Another cause for infertility is retrograde ejaculation, a condition in which semen is not ejaculated out of the urethra and instead enters the bladder. This could be caused by other health conditions such as diabetes, surgeries or spinal injuries.

Other medical causes include hormonal imbalances (low testosterone or male hypogonadism), inherited disorders like Kinefelter’s syndrome (presence of two X chromosomes and one Y chromosome) or cystic fibrosis, taking certain medication, and tumors.

Psychological factors and sexual problems such as erectile erectile dysfunction or premature ejaculation ejaculation could also affect fertility.

Certain risk factors that could impact male fertility include smoking, alcohol abuse, anabolic steroids, use of certain recreational drugs, excessive stress, and excessively intense exercises.Overexposure to environmental toxins, pesticides, radiation, mercury, lead, paint, and heavy metals could also affect fertility.

Symptoms

The primary symptom for infertility is the inability to conceive despite regular unprotected sexual intercourse over a substantial period of time, typically over a year. There may be no outward symptoms hinting at an underlying problem and the appearance of semen may appear normal.

In some cases, there may be other symptoms associated with medical factors that can impact fertility, such as blockage in the sperm duct, hormonal imbalances or genetic disorders. There may be problems with sexual function, pain or swelling in the testicular area, decreased body or facial hair (indicative of hormonal imbalance) and a low sperm count.

Diagnosis

Diagnosis could involve a number of tests for both the male and female partners. In several cases, the inability to conceive is a result of a combination of factors that could affect the female partner or the male partner or both. It is thus important for both partners to seek medical attention.

For males, diagnosis would typically involve a medical history about past surgeries, infections, illnesses, inherited conditions, drug use, medication, sexual habits and frequency of sexual intercourse. There would also be a physical examination of the genital area for any apparent signs of a medical cause.

Diagnosis also includesobtaining a semen sample and sending it for laboratory testing. This is done to check sperm count and detect any abnormalities in the movement and shape of the sperm. The sperm count may vary at times and usually different samples are tested over a period of time for accuracy.

Additional tests that may be performed are scrotal and transrectal ultrasounds (to look for any blockages or other problems), genetic tests, blood tests to determine level of testosterone and other hormones, and genetic tests to ascertain existence of inherited conditions. Specialized sperm function tests may also be carried out.

Treatment for Male infertility

The treatment for male infertility would depend on the underlying cause. Even if the cause is unknown (as is the case in a number of instances), some treatments may still be recommended.

If the underlying cause is an infection, antibiotic treatments are prescribed for the same. Conditions like varicocele may require surgical correction. Hormonal imbalances may be corrected through medications or hormone replacement therapies. Psychological conditions and problems with sexual intercourse are dealt with through counseling or medication.

In cases where such measures do not or would not work and conceiving is not possible in a natural way, assisted reproductive technology treatments (ART) may be recommended. In ART treatments, sperm is extracted surgically or obtained through normal ejaculation and inserted in the female partner’s genital tract or for in vitro fertilization. In some cases where even ART would not be possible, couples are suggested use of donor sperm or are introduced to adoption.