Male infertility: symptoms, causes and treatment

Male infertility: symptoms, causes and treatment

Male infertility. The failure to conceive after one year of regular sexual intercourse.

It is sensible to run diagnostics of male infertility as the first stage for any reason of an infertile marriage including female infertility. It helps avoid tactical mistakes as well as unnecessary losses in time and money.


The male reproductive system

Male reproductive organs are situated both inside and outside the body. The testicles produce sperm and the hormone testosterone that plays a key role in the development of male sexual characteristics. From the testicles the sperm passes into the spiral channels of the epididymis. The epididymis is the organ that keeps and nurtures the sperm while it matures. The mature sperm passes through the vas deferens into the seminal vesicles which are two sack-like glands that store the sperm.

The whole process of producing sperm until the moment when it is completely mature takes approximately 72 days. During ejaculation the secretion of the seminal vesicles mixes with a thick liquid from the prostate and creates the semen.

Male’s spermatogenesis

The development of normal and mature sperm (spermatogenesis) is the basic factor of male fertility i.e. the ability to achieve a pregnancy in a fertile female. Sperm production depends on three hormones –follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. Both FSH and LH in a man’s body affect the testicles. The hormone FSH stimulates production of sperm in Sertoli cells and hormone LH stimulates production of sperm in Leydig cells. In Sertolli cells immature sperm becomes mature and turns into spermatozoa. However these spermatozoa will not become motile until they pass through the epididymis. Having acquired the ability to move, the sperm then stays in the vas deferens up to the moment of ejaculation.

The reasons of male infertility

After ejaculation the sperm lives in the body of a woman and can fertilize the egg for up to between 48 and 72 hours. That is why sexual intercourse every 2 or 3 days during ovulation is considered to be most favourable for conception.

As regards fertilization, motility of sperm is as important as the sperm count. Men with a low sperm count can still be fertile providing that their spermatozoa have good motility.

Both the volume of seminal fluid and the morphology of the sperm can affect fertility.

Moreover, male’s fertility can be affected by varicose veins in the scrotum which is called varicocele. By the way this is one of the most widespread reasons of male infertility. Finally, reproductive health of men can be affected by such factors as obstruction in the reproductive organs, ejaculation difficulties, use of medications, testicular dysfunction or disorders of testicular development.

There are two main types of male infertility – secretory and obstructive. The secretory type of male infertility means that the spiral channels of the testicles are not capable of producing spermatozoa. The obstructive form of male infertility means that there are some obstacles in the way of spermatozoa passing to the urethra.

The secretory form of male infertility

In this form, testicles are not capable of producing the quantity of sperms which is enough to reach and fertilize an egg. The spermatozoa may not be motile enough or the majority of spermatozoa can have defects in their morphology.

The secretory form of male infertility is always based on some effect on the testicles. The most widespread disease leading to a dysfunction of sperm production is varicose veins in the testicles (varicose). Varicocele is the condition when excessively distended testicular veins are unable to provide sufficient blood outflow from the testicle which results in blood congestion. Blood supply in the tissue of the testicle is disturbed, therefore its function is depressed. In the majority of cases varicocele is left-sided. However, after a while the blood flow of the other healthy testicle gets disturbed too followed by other triggered mechanisms. The disease may result in a considerable drop in sperm production by both testicles which is in fact the secretory form of infertility.

Hydrocele is characterized with similar symptoms. In this disease a considerable amount of liquid accumulates in the scrotum and this puts pressure on the testicles. If the disease remains untreated for a long time, the pressure can lead to the disruption of the blood flow in the tissue of the testicle which may result in an unfavorable diagnosis. Groin hernia may lead to the same condition.

Another disease which leads to male infertility is cryptorchidism or undescended testicle, when one or both testicles fail to move into the scrotum. Cryptorchidism is quite a rare disease. Modern approaches to the treatment of cryptorchidism consider that by the age of 7 the treatment should be finished completely and the testicles should definitely be in the scrotum. If it does not happen, the function of the testicles can be considerably lowered.

Another disease which results in the same condition is epidemic parotitis or mumps. The virus that causes such a disease usually affects different glands of the body. Almost always it all starts with swelling of the salivary glands, the face of the patient acquires a round shape and “hamster cheeks” which are the distinctive characteristic of the disease. The genitals get affected too, especially boys’ testicles. If the inflammation is too strong and the necessary treatment has not been carried out, a possible consequence is testicular dysfunction.

Damage to the seminiferous epithelium can be caused by different external factors. The lasting effect of penetrating radiation can cause not only radiation sickness and other various dysfunctions in the body, but also badly damage the seminiferous epithelium of the testicles which leads to a considerable drop in the sperm count. Electromagnetic oscillations critical in their degree or duration of impact may have the same effect. This information is especially important for those who like wearing modern communication devices on the belt. The research about the effect of the mobile phones on this function of a man has not answered the question decisively. But very likely the result of the research will not be encouraging.

It stands to mention that high temperatures have a depressive effect on testicular function. It is an important piece of information not only for welding operators and coal heavers but also for those who like to go to the sauna or take a hot bath. It is better to finish such procedures by having a cool shower or at least letting your body cool down before you start getting dressed.

Regular cycling, especially professional cycle training is very unfavorable for the genital function. Pressure and constant hitting of the scrotum can depress testicular function or lead to a complete dysfunction. That’s why you should avoid bicycle rides and regular cycle training during infertility treatment. Thermal regulation of the testicles can be interrupted by tight underwear which press the testicles tightly to the body.

The following diseases can cause testicular dysfunction: syphilis, tuberculosis, typhoid, hormonal dysregulations, long-term ingestion of antitumour and antiepileptic medications, some antibiotics, steroid hormones, antiandrogens. Some factors can cause a decrease in sperm count. Among such factors there are the following: long-term stress, lack of protein and vitamins in food, unfavourable ecology factors, chronic lack of sleep, cigarette, alcohol, drug abuse.

In order to detect this type of infertility a spermogram is often not enough. Sometimes a biopsy of the testicles is required. This does not only help diagnose the condition of the tissue of the testicles. It often helps find out about the primary cause of the disease.

During the treatment of the secretory form of male infertility, the cause of the disease should be eliminated. After the doctors have cured varicocele, hydrocele, parotitis, removed any unfavorable factors, cancelled medications etc, general therapy is prescribes which aims to improve the spermatogenic function of the testicle. It includes not only ultimate nutrition and normalization of the lifestyle, but also therapy with vitamins and special medications that improve blood supply of the organs of the scrotum. Sometimes stimulating hormone therapy is necessary.

On the whole, the treatment of the secretory type of male infertility is a very long, difficult and diligent process which does not have an unfavourable prognosis.

The obstructive form of male infertility

In this form of male infertility spermatozoa can not move along the vas deferens from one or both sides. When the passability dysfunction is one-sided, there is a reduced sperm count, when the dysfunction is both-sided, there are no spermatozoa at all.

The development of obliteration i.e. impassability of the sperm ducts can result from all sorts of reasons. The most frequent reason is epididymite – inflammation of the epididymis in the case history. After the inflammation is over, the ducts of the epididymis become adhered or blocked up, so not a single spermatozoid from the testicle can get into the seminal vesicle.

Ignored or untreated traumas of the testicles or the groin area can lead to infertility in men. Often the impassability of the vas deferens results from the accidental damage of the sperm ducts during the surgical operation on pelvic organs – bladder, ureters, rectum etc. There are cases when a vas deferens is pressured by the cyst or the tumor of the epididymis. The innate absence of either epididymis or a sperm duct play an important role in male infertility. Other diseases that can be the cause of such an unpleasant complication is syphilis and tuberculosis.

Special methods are used in order to diagnose the obstruction of the vas deferens. With the help of these methods the doctors can identify the presence, localization and the length of the obliteration area. The treatment of the obstructive form of male infertility means recovering the passability of the vas deferens with the help of a surgical operation. The success of the operation to the utmost depends on the length of the obliteration area. Considering it there are two options of possible
treatment: either the resection of the obstructed area or making a new passage for spermatozoa. Sometimes an anastomosis with the opposite vas deferens is created.

Immunological incompatibility of the partners

In 10% of all infertile marriages it turns out that neither of the spouses has a disease that may lead to infertility. Moreover, both of them can have children from other marriages. The reason of infertility in this case becomes immunological incompatibility of the partners. Put it differently it means that the woman is allergic to the sperm or the components of the sperm of her husband. Some tests including an allergy test with the ejaculate of the spouse can diagnose this type of infertility. Unfortunately, nowadays this form of infertility is a really serious problem for andrologists and gynecologists all over the world. It is not always possible to get a favorable outcome of the situation by usual means.
The basic way to diagnose male infertility is spermogram

Psychological aspects of infertility

In the vast majority of cases even if a man knew about his diseases and was aware of possible complications, the news about his infertility is a bolt from the blue. Every woman will feel shocked and very stressed if she finds out that she can not have children but it can not be compared with the tragedy that a man suffers at the same news about himself. The most representatives of the stronger sex subconsciously identify the idea of masculinity with sexual function. The inability to have children sometimes strikes a heavy blow to a man’s fragile self-esteem.

There are many cases when men would leave their families just because they could not have children even though their spouses were ready to put up with it and solve the problem in a different way, for example, adopt a child. Many of them thought they did not have the right to start a family or just serious relationship with women. It eventually led to alcohol and drug abuse. Even if the spouses decided to preserve their family and start treatment, the relationship between them may change irretrievably.

Many men are afraid to find out that they are infertile so much that they refuse any medical examinations. It becomes very difficult if not impossible to convince men to seek specialists’ advice.

Possible causes of male infertility:

  • Testosterone deficiency of various etiology
  • Inflammatory diseases of the reproductive system
  • Genetic abnormalities

 

  • Erectile dysfunction
  • Ejaculatory dysfunction (as a side-effect of diabetis)
  • Epidemic parotitis in the case history
  • Abnormal development of genitals



What diseases trigger male infertility:

  • Erectile dysfunction
  • Epidemic parotitis
  • Diabetis
  • Varicocele


In case of infertility a man should seek the advice of the following specialists:

  • Urologist/ andrologist
  • Endocrinologist/ andrologist


17 Январь 2012
Author: Dr. Lara Stoun

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