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Male Infertility Causes – Introduction

Infertility is defined as, when a couple fails to conceive after one year of unprotected sexual intercourse. Amongst this, around 30-35% cases are due to female infertility, in 35% of cases male factor is responsible, 20% cases are due to combined causes and 10% are due to unexplained causes.
The main function of the male reproductive system is to produce sperm and testosterone, but some other underlying mechanisms are far more complex and yet to be completely understood. Disruption of male fertility may be reflected by impaired sperm parameters through multivariate factors at different levels. Causes of infertility in male may be at the pretesticular or neuroendocrine regulatory levels, intratesticular sites, affecting the functions of Sertoli cells, Leydig cells, and germ cells, or at the post testicular level, impairing sperm maturation and transport. Also, in some cases, male reproductive immunological factors, as well as reproductive genetics modulations, may also be responsible. Hence, proper evaluation of male infertility at different levels is of utmost importance for its effective management, so that targeted treatment to specific male factors according to the causes of infertility in male, can be given.

Symptoms of Male Infertility

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms.
In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle or a condition that blocks the passage of sperm causes signs and symptoms. Signs and symptoms you may notice include:

  • Reduced sexual desire or problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Decreased facial or body hair or abnormal breast growth are signs of hormonal abnormality
  • A lower-than-normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

Causes of Infertility in Male

After the basic evaluation of male partner, we need to establish the male infertility causes so that treatment can be individualized, and the causative factor can be treated. Most of the male factor infertility is idiopathic. The list of known factors is divided into four major categories:

  1. Hypothalamic pituitary disorders (1-2%)
  2. Sperm transport defects (10-20%)
  3. Primary gonadal disorders (defect at the level of testes – 30-40%)
  4. Unexplained/Idiopathic infertility (40-50%)

These four categories may fall under either medical, environmental or lifestyle causes. Let’s see them in detail.

Medical causes

Problems with male fertility can be caused by several health issues and medical treatments:

  • Varicocele: A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of infertility in males and found in about 16 out of 100 men. They harm sperm growth by blocking proper blood drainage. It may be that varicoceles cause blood to flow back into your scrotum from your belly. The testicles are then too warm for making sperm. This can cause reduced sperm quality and quantity.
  • Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved through various advanced methods we use at Indira IVF.
  • Ejaculation Issues: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. This happens when nerves and muscles in the bladder don’t close during orgasm or climax. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate, or urethra. If you notice cloudy urine after ejaculation or less fluid or dry ejaculation, then it could be pointing towards retrograde ejaculation.
  • Antibodies that Attack SpermAnti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them. These antibodies keep the sperm from moving and working normally. They make it difficult for sperm to swim to the fallopian tube and enter an egg. This is a very rare cause of infertility in males.
  • Tumors: Cancers and non-malignant tumors can affect the male reproductive system directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation, or chemotherapy to treat tumors can affect male fertility.
  • Undescended Testicles: In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
  • Hormone Imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have several possible underlying causes.
  • Defects of Tubules that Transport SpermMany different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma, or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
  • Chromosome DefectsInherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis and Kallmann’s syndrome.
  • Problems with Sexual IntercourseThese can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
  • Celiac DiseaseCeliac disease is a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to infertility. Fertility may improve after adopting a gluten-free diet.
  • Certain MedicationsTestosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some ulcer drugs, some arthritis drugs and certain other medications can impair sperm production and decrease male fertility. Also, drugs to ease digestive problems, infections or high blood pressure can impair sperm production or quality and decrease male fertility.
  • Prior SurgeriesCertain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

Environmental Causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function.
These include industrial chemicals like pesticides, herbicides, solvents, paint material or heavy metal or radiation exposure may also lead to low sperm count.

Health, Lifestyle, and Other Causes

Lifestyle and conditions caused due to lifestyle changes contribute greatly to infertility in men.
Excessive use of drugs like anabolic steroids or other illicit drugs can bring about infertility. Excess use of alcohol or smoking may also cause erectile dysfunction or lower the sperm count.
Obesity can impair fertility in many ways. A stationary lifestyle, wearing tight clothes may increase the temperature in your scrotum and may slightly reduce sperm production.

Prevention of Male Infertility

Male infertility is generally detected very late and by then men have already formed many habits that are difficult to let go of. But, here are a few things you can avoid or follow to ensure you don’t have to face any such issues later in life.

  • Don’t smoke.
  • Limit or abstain from alcohol.
  • Steer clear of illicit drugs.
  • Maintain a healthy weight.
  • Avoid things that lead to prolonged heat for the testicles.
  • Reduce stress.
  • Avoid exposure to pesticides, heavy metals, and other toxins.

Treatment of Male Infertility

The treatment of male infertility involves helping your partner get pregnant. This may be through:

  • Artificial insemination: This method puts many healthy sperm at the entrance of the cervix or right into the partner’s uterus. The sperm can then make their way to the fallopian tubes.
  • IVF: With In vitro fertilization (IVF) your fertility expert will collect your partner’s eggs and mix it with a lot of high-quality sperm. He or she may mix the eggs and sperm in the lab and introduce it in your partner’s fallopian tube.
  • Intracytoplasmic sperm injection (ICSI): Your doctor injects a single sperm into an egg. Fertilization then takes place under a microscope. Your provider puts the fertilized egg in your partner’s uterus.

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