Male Infertility

Infertility can be either primary; having never been pregnant or secondary; the inability to conceive after having been pregnant previously. There is a 25 percent chance of conceiving pregnancy per menstrual cycle. Fifty percent of couples will conceive within six months and eighty five percent of couples will conceive within a year’s time. Male factor infertility accounts for 20 to 30 percent of cases. A combination of male and female factors account for an additional 20 percent of cases.

Male infertility is any condition in which the man adversely affects the chances of initiating a pregnancy with his female partner. Most commonly, those problems arise when the man is unable to produce or deliver fully-functioning sperm.

Risk Factors:

Many things can affect the ability of a couple to conceive. Some of these factors may include:

  • Age of the partners
  • Overall health
  • Past surgeries
  • Substance abuse
  • Medications
  • Pesticide exposure

Causes:

Your doctor will be interested in any factor, including possible structural and other defects in the reproductive system, hormonal deficiencies, illness or even trauma that might be impairing your fertility. The doctor's investigation will center on many possible combinations of factors, the most common of which are:

Sperm disorders: Problems with the production and development of sperm are the most common problems of male infertility. Sperm may be underdeveloped, abnormally shaped or unable to move properly. Or, normal sperm may be produced in abnormally low numbers (oligospermia) or seemingly not at all (azoospermia).

Varicoceles: These dilated scrotal veins are present in 16 percent of all men but are more common in infertile men—40 percent. They impair sperm development by preventing proper drainage of blood. Varicoceles are easily discovered on physical examination since the veins feel distinctively like a bag of worms. They may also be enlarged and twisted enough to be visible in the scrotum. This is the most common correctable cause of male infertility.

Retrograde ejaculation: Retrograde ejaculation occurs when semen pushes backwards into the bladder instead of out the penis. This is caused by the failure of nerves and muscles in the bladder neck to close during orgasm. It is one of several difficulties couples may have delivering sperm to the vagina during intercourse. Retrograde ejaculation can be caused by previous surgery, medications or diseases affecting the nervous system. Signs of this condition may include cloudy urine after ejaculation and diminished or "dry" ejaculation with orgasm.

Immunologic infertility: Triggered by a man's immunologic response to his own sperm, antibodies are usually the product of injury, surgery or infection. In attacking the sperm, they prevent normal movement and function of the sperm. Although researchers do not yet understand just exactly how antibodies damage fertility, they know that these antibodies can make it more difficult for sperm to swim to the uterus and penetrate eggs.

Obstruction: Blocking sperm from its normal passage, obstructions can be caused by a number of factors, such as repeated infections, prior surgery (including vasectomy), inflammation or development problems. Any portion of the male reproductive tract, such as the vas deferens or epididymis, can be obstructed, preventing normal transport of sperm from the testicles to the urethra, where it leaves the body during ejaculation.

Hormones: Hormones produced by the pituitary gland are responsible for stimulating the testicles to make sperm. Therefore, when levels are severely low, poor sperm development can result.

Genetics: Genetics play a central role in fertility, particularly since sperm carry half of the DNA mix to the partner's egg. Abnormalities in chromosomal numbers and structure as well as deletions on the important Y chromosome present in normal males can also impact fertility.

Medication: Certain medications can affect sperm production, function and ejaculation. Such medications are usually prescribed to treat conditions like arthritis, depression, digestive problems, infections, hypertension and even cancer.

>Diagnoses:

The process begins with a complete history and physical exam and is usually followed by blood work and semen analysis. From a sample of semen routinely obtained through masturbation into a sterilized cup, the physician will be able to assess factors—volume, count, concentration, movement and structure of spermatozoa—that hinder conception.

Even if the semen analysis shows low sperm numbers, or even no sperm, it does not necessarily mean absolute infertility. Low values in any of the above categories may just indicate a problem with the development or delivery of sperm that simply requires further evaluation.

For instance, your physician may order a transrectal ultrasound, an imaging test that places a probe into the rectum to beam high-frequency sound waves to nearby ejaculatory ducts. This test can help your physician determine if these structures are either poorly developed or obstructed with cysts, calcifications or other blockages.

A testicular biopsy comes into play when a semen analysis shows very low number of sperm or no sperm. This test is performed in an operating room under general or regional anesthesia through a small cut in the scrotum. It may also be done in a clinic using a needle inserted through skin over the testicle that has been anesthetized. In either case, a small piece of tissue is removed from each testicle for microscopic evaluation. The biopsy serves two purposes: to determine the cause of infertility, and, if necessary, to retrieve sperm for use in assisted reproduction.

Besides a semen analysis, your doctor may order a hormonal profile to discover the sperm-producing ability of your testicles and to rule out serious conditions. For instance, follicle-stimulating hormone (FSH) is the pituitary hormone responsible for stimulating testicles to produce sperm. High levels may indicate that the pituitary is trying to stimulate the testicles to make sperm, though they are not responding.

Treatment:

The treatment for male infertility depends on the specific problem. In some severe cases, no treatment is available. However, many times there are a mix of medications, surgical approaches and assisted reproductive techniques (ART) that are available to overcome many of the underlying fertility problems. These options include:

Surgery: Minor outpatient surgery (varicocelectomy) is frequently used to repair dilated scrotal veins (varicoceles). Studies have shown that repairing these dilated veins results in improved sperm movement, concentration and structure. In some cases, obstruction causing infertility can also be surgically corrected. In the case of a previous vasectomy, surgery using an operating microscope has been found to be very successful in reversing the obstruction.

Medication: Medicine is key to correcting retrograde ejaculation and immunologic infertility. In addition, pituitary hormone deficiency may be corrected with drugs such as clomiphene or gonadotropin.

If these techniques fail, fertility specialists have a variety of other high-tech assisted reproductive techniques that promote conception without intercourse. 

Citations:

Male Infertility. (2013, July). Retrieved October 24, 2013, from Urology Care Foundation website:

http://www.urologyhealth.org/urology/index.cfm?article=102&display=1


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