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Male Infertility

MALE INFERTILITY

Male Infertility - German Medical CenterFor ages, Infertility has long been considered a woman’s problem. But as it turns out, an estimated 15% of couples are considered infertile, with approximately 35% due to female factors alone, 30% due to male factors alone, 20% due to a combination of female and male factors, and 15% unexplained. A diagnosis of male infertility can be one of the toughest challenges a man can face. For some, it can be devastating. Not being able to father a child can make a man feel heart broken and demoralized.

A man’s fertility normally relies on the quantity and quality of his sperm. Male infertility is due to low sperm production, abnormal sperm function, or blockages that prevent the provision of sperms. Certain Illnesses, injuries, chronic health problems, and lifestyle habits can exert a negative impact on male fertility.

The inability to conceive a child for more than one year of normal and uninterrupted marital relationship could be the only sign that triggers a concern about fertility. There may be no other obvious symptoms. Nevertheless, in presence of an underlying problem such as hormonal abnormality, inherited/genetic disorder, testicular ailment or dilated veins around the testicle, there could be associated symptoms, for example:

  • Testicular pain or lump
  • Difficulty with ejaculation or small volumes of fluid ejaculated, decreased desire or difficulty maintaining an erection (erectile dysfunction)
  • Inability to smell properly
  • Abnormal breast enlargement (= male gynecomastia)
  • Decreased facial or body hair growth
  • Abnormal sperm count

A. Medical Problems: the most common of which include:

The most common of which include:

  • Varicocele: Abnormal dilatation of the veins that drain the testicles. It is the most common reversible cause of male infertility. It can exert a negative impact on the quantity and quality of sperm production. One of the theories behind such impact is the abnormal rise in temperature around the testicles. Surgical management of the Varicocele can improve sperm count and function, and may potentially improve outcomes, especially when associated with assisted reproductive techniques such as in-vitro fertilization or intra-cytoplasmic sperm insemination.
  • Trauma: Testicular trauma is one of the most common acquired causes of male infertility. The unique position of the testicles outside the abdomen makes it more vulnerable to both thermal and physical trauma.
  • Infection: Certain reproductive tract infections can have a negative impact on the count and/or quality of sperms. It can also cause scarring that blocks the passage of sperms.
  • Antibodies that attack sperm: Abnormal immune response which ends up with the human body`s antibodies attacking its own sperms.
  • Undescended testicles: During fetal development one or both testicles may fail to descend from the abdomen into the scrotum (the sac that normally contains the testicles).
  • Hormone imbalances: Male Infertility can be due to disorders of the hormonal system controlling sperm production, including the hypothalamus, pituitary, thyroid and adrenal glands.
  • Abnormal ejaculation: Retrograde ejaculation happens when the semen is ejaculated into the bladder with orgasm instead of emerging out of the penile organ. Several health ailments can cause retrograde ejaculation, including diabetes and spinal injuries.
  • Certain medications: Cancer treatments (chemotherapy), long-term use of anabolic steroid, and certain antifungal medications can impair sperm production and decrease male fertility.
  • Chromosomal abnormalities: Genetic disorders cause abnormal development of the male reproductive organs.
  • Sexual dysfunction: These may include difficulty in sustaining and/or maintaining an erection sufficient for intercourse (erectile dysfunction).

 

B. Environmental Factors

  • Industrial chemicals: Extended exposure to benzenes, pesticides, herbicides, and lead may exert a negative impact on sperm count.
  • Heavy metal exposure: Exposure to lead or other heavy metals also may cause infertility.
  • Radiation or X-rays: Exposure to radiation can reduce sperm production.

 

C. Lifestyle Habits

  • Tobacco smoking: Several researches, backed up by a staunch scientific opinion, have stated that smokers may have a lower sperm count than do those who do not smoke.
  • Emotional stress: Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, may negatively affect sperm count.
  • Illicit drug use: Anabolic steroids taken to stimulate muscle strength and growth can cause the atrophy of the testes and decline in sperm production. Abuse of cocaine or marijuana may reduce sperm count and motility also.

Diagnosing potential cause(s) of male infertility may take time, so don’t get discouraged if you do not receive an answer promptly. Testing for male infertility usually begins with a health care provider doing inquiring medical history in details and undergoing a thorough physical examination, to be followed by a semen analysis test:

 

History

Your trusted Andrologist will thoroughly inquire about your childhood growth and development; sexual development during puberty; sexual history; past illnesses or infections; past surgeries; medication history; exposure to certain environmental agents (radiation and toxic chemicals); plus any earlier fertility testing.

 

Physical Examination

usually includes measurement of height and weight, assessment of body fat and muscle distribution and power, inspection of the skin and hair pattern, and examination of the genitals and breasts. Particular attention is given to clinical assessment for presence of Varicocele (=dilated veins of the spermatic cord).

 

Semen Analysis

This is the core part of the assessment of male infertility. This analysis provides information about the volume of semen and the sperm number, motility, and shape. A man should avoid ejaculation (sex and masturbation) for a minimum of 3 days before providing the semen sample.

 

Blood Tests

Blood tests provide information about the hormones that control the process of sperm production. Testosterone, Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), and Prolactin are the main hormones to be checked.

 

Genetic Tests

If any genetic or chromosomal abnormality is suspected, specialized blood tests may be needed to check for absent or abnormal regions of the male chromosomes.

 

Scrotal Ultrasound

Can detect the presence of testicular Varicocele or other problems in the testicles and supporting structures.

 

Post-ejaculation urinalysis

Presence of sperms in urine can indicate your sperm are traveling backward into the bladder instead of outside during ejaculation (= retrograde ejaculation).

 

Antisperm Antibody Test

This is to detect the presence of antibodies attacking its own sperms, due to an immune-related abnormality. Sperm contain unique antigens that are not recognized as self by the body’s immune system because of the blood-testis barrier. Antisperm antibodies may form when the blood-testis barrier is breached because of infection, vasectomy, testicular torsion, cryptorchidism, or testicular trauma. Antibodies that are bound to sperm decrease the sperm’s ability to penetrate the cervical mucus and fertilize the ovum.

Male Infertility: New Treatments, more pregnancies

The ultimate goal of male infertility treatment is to restore man`s ability to father a child. Even if an exact cause for the infertility is not clear after thorough assessment, your trusted Andrologist can recommend treatments or procedures to facilitate conception.

The female partner is also recommended to be checked. This can help to determine if she will require any associating specific treatments, or if the couple would want to proceed with assisted reproductive techniques.

Treatments for male infertility are directed to treating the potential cause, and may include:

  • Surgery: For example, a Varicocele can often be surgically corrected or an obstructed vas deferens repaired. In case where no sperm can be retrieved in the ejaculate, sperms can be retrieved directly from the testicles through testicular biopsy.
  • Treating infections: Antibiotic treatment might cure an infection of the reproductive tract.
  • Management of sexual dysfunction: Medication or counseling can help improve fertility in conditions such as erectile dysfunction.
  • Hormonal Treatments
  • Assisted reproductive technologies (ART):  If the male partner’s semen contains very few sperm, no sperm, abnormal sperm, or sperm with poor motility, assisted reproductive technologies (ART) can often help. These techniques offer hope to some infertile couples who could not achieve pregnancy without them (e.g.  IVF and ICSI).

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