Male infertility

Male infertility is a term that refers to infertility in male humans.

Male infertility is involved in a sexually paired couple's inability to conceive in a significant number of cases, with estimates ranging from 40-50%. ^[1][2][3]

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Causes

Factors relating only to male infertility include^[4]:

Pretesticular causes

• Hypogonadism due to various causes
• Drugs, alcohol, smoking
• Strenuous riding (Bicycle riding,^[5] Horseback riding)

Testicular factors

Testicular factors of male infertility include:

• Bad semen quality
  • Abnormal sperm morphology
  • oligospermia
  • Azoospermia (complete lack of sperm in semen, can be due to scar tissue in testicle)

Factors that, in turn, affect the semen quality include:

• Genetic defects on the Y chromosome
  • Y chromosome microdeletions
• Abnormal set of chromosomes
  • Klinefelter syndrome
• Neoplasm, e.g. seminoma
• Idiopathic failure
• Cryptorchidism
• Varicocele (14% in one study)^[6][7]
• Trauma
• Hydrocele
• Mumps^[8]
• Malaria
• Testicular dysgenesis syndrome
• Defects in USP26 in some cases^[9]

Posttesticular causes

• Vas deferens obstruction
• Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
• Infection, e.g. prostatitis
• Retrograde ejaculation
• Hypospadias
• Impotence
• Acrosomal defect/egg penetration defect

Diagnosis

The diagnosis of infertility begins with a medical history and physical exam by a urologist, preferably one with experience or who specializes in male infertility. The provider may order blood tests to look for hormone imbalances or disease. A semen sample will be needed. Blood tests may indicate genetic causes.

Efficiency

In the majority of cases of male infertility and low sperm quality, no clear cause can be identified with current diagnostic methods.

Medical history

The cornerstone of the male partner evaluation is the history. It should note the duration of infertility, earlier pregnancies with present or past partners, and whether there was previous difficulty with conception.

The history should include prior testicular (penis) insults (torsion, cryptorchidism, trauma), infections (mumps orchitis, epididymitis), environmental factors (excessive heat, radiation, chemotherapy), medications (anabolic steroids, cimetidine, and spironolactone may affect spermatogenesis; phenytoin may lower FSH; sulfasalazine and nitrofurantoin affect sperm motility), and drug use (alcohol, smoking, marijuana).

Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner's previous fertility experiences are important.

Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.

The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy (retrograde ejaculation), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).

Physical examination

A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastia may suggest androgen deficiency.

The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.

The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.

Sperm sample

Main article: semen quality

The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed. This is the most common type of fertility testing^[10].

Blood sample

A blood sample can reveal genetic causes of infertility, e.g. a Y chromosome microdeletion, cystic fibrosis.

Prevention

Some strategies suggested or proposed for avoiding male infertility include the following:

• Avoiding smoking^[11] as it damages sperm DNA
• Avoiding drugs and medications known to cause fertility problems, like steroids and some antifungal medications.
• Avoiding excessive exercise.
• Avoiding exposure to environmental hazards such as pesticides and heavy metals such as lead, mercury and cadmium.
• Avoiding frequent hot baths or use of hot tubs.
• Avoiding tight underwear or pants.
• Eating a diet with adequate folic acid, vitamin C, Zinc, calcium, magnesium, selenium, iron loaded food.
• Getting early treatment for sexually transmitted diseases.
• Having regular physical examinations to detect early signs of infections or abnormalities.
• Keeping diseases, such as diabetes and hypothyroidism, under control.
• Practicing safer sex to avoid sexually transmitted diseases.
• Taking a lycopene supplement.^[12]
• Wearing protection over the scrotum during athletic activities.

Treatment

In cases of posttesticular causes, infertility may often be treated surgically. However, for sperm quality causes, e.g. oligospermia, there is no effective medication^[13]. Still, IVF or even ICSI may be an alternative.^[13]

References