Approximately 8-16% couple are unable to conceive after one year of unprotected intercourse, of which approximately 18% of the cases are because of the male factor. This number is increasing gradually because of various causes like lifestyle, environmental pollution likes pesticides, chemicals etc
Male infertility has been associated with several genetic and non-genetic causes. In 40% men no cause of infertility is found.
Causes of Male Infertility
Abnormalities in the semen parameter:
Any sperm count less than the normal parameters given above can affect the possibility of successful pregnancy.The count may be normal but if the sperms are immotile or motility is decreased then again the possibility of infertility is there. The sperm morphology is a very important parameter for achieving a successful pregnancy.
Abnormalities in the seminal fluid
If the seminal fluid is very viscose , then process of liquifactition does not take place and this kind of inhibits the sperm passage into the woman’s reproductive tract.
Problems with the Ductal system-Obstructive Azoospermia
Sperm carrying ducts may be missing or blocked. In patients with CBAVD ,Congenital bilateral absence of vas deference ,A patient may have bilateral (both sides) congenital (from birth) absence of the vas deferens.
The male factor infertility may be because of obstructions.They may have become mechanically blocked during hernia or hydrocoele repairs or infection because of the scar tissue. If there is block on both sides no sperm will come through.
In some situations the ducts may be repaired orblock opened , If this is not possible, the sperm may be surgically extracted and used in conjunction with ICSI techniques to attempt a pregnancy.
Varicoceles
Varicoceles are dilated veins in the scrotum. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on the sperm production.
Immunologic Infertility
Men can develop an immunologic response, (antibodies) to their own sperm-Anti sperm Antibodies. The causes for this may include testicular trauma, testicular infection, large Varicoceles or testicular surgery. Sometimes there are unexplained reasons why this occurs. These antibodies have a negative effect on fertility.
Most likely these antibodies act negatively,they make it more difficult for the sperm to penetrate the partner’s cervical mucus and make its way into the uterus. There is difficulty for the sperm to fertilize the egg and affect the fertility.
These patients need to go through intra-uterine inseminations.The presence of anti-sperm antibodies is usually an indication to inject the sperm directly into the egg (ICSI) instead of conventional IVF.
Difficulties with erections and ejaculation
About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse.
Testicular Failure
This generally refers to the inability of the sperm producing part of the testicle to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons. The testicle may completely lack the cells that divide to become sperm (“Sertoli Cell-Only syndrome”). There may be an inability of the sperm to complete their development (” maturation arrest”). Sperm may be made in such low numbers that few if any successfully travel through the ducts and into the ejaculated fluid .(Even in the case where the testes are only producing low numbers of sperm, one could attempt to get pregnant with the use of surgical sperm retrievals like PESA/TESA/TESE with ICSI procedure to fertilize the eggs.
Cryptorchidism
Cryptorchidism may be a cause of testicular failure. When a baby boy is born without the testes having fully descended into the scrotum the condition is known as cryptorchidism.
Since the testes are very sensitive to temperature, if they do not descend into the scrotum prior to adolescence, then they will stop producing sperm altogether. They have a higher rate of malignancy. Cryptorchidism is often associated with male factor infertility. Large percentages of men who have a single testis that is crypt orchid have normal fertility.
Drugs
There are a number of fairly common drugs, which may have a negative effect on sperm production and or function. They include:
- Ketoconazole (an anti-fungal)
- Sulfasalazine (for inflammatory bowel disease)
- Spironolactone (an anti-hypertensive)
- Calcium Channel Blockers (anti- hypertensive)
- Allopurinol, Colchicine (for gout)
- Antibiotics: Nitro furan, Erythromycin, Gentamicin
- Methotrexate (cancer, psoriasis, arthritis)
- Cimetidine (for ulcers or reflux)
The following list of drugs can cause Ejaculatory Dysfunction
- Antipsychotics: Chlorpromazine, Haloperidol, Thioridazine
- Antidepressants: Amitriptyline, Imipramine, Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft)
- Antihypertensive: Guanethidine, Prazosin, Phenoxibenzamine, Phentolamine, Reserpine, Thazides
Hormonal Abnormalities
The testicles need pituitary hormones to be stimulated to make sperm. If these are absent or severely decreased the testes will not maximally produce sperm. Importantly, men who take androgens (steroids) either by mouth or injection for body building shut down the production of hormones for sperm production.
A hormonal profile must be performed on all men with male factor infertility. This will help rule out serious medical conditions, give more information on the sperm-producing ability of the testes, and may reveal situations where hormonal treatment is indicated.
Infections
Men may have infections of their reproductive tract. These may include infections of the prostate called prostatitis, of the epididymis called epididymitis, or of the testis that is orchitis.
Post-pubertal viral infections of the testes may cause significant damage (atrophy) of the testes and may cause absolute and irreversible infertility. Bacterial infections or sexually transmitted diseases may cause blockages at the sperm ducts. The patient may have normal production of sperm, but the ducts carrying it are obstructed.
Active bacterial or viral infections may have a negative effect on sperm production or sperm function. White blood cells, which are the body’s response to infection, may also have a negative effect on sperm membranes making them less hearty.
If excessive white blood cells or bacteria (more than 1 million/cc) are seen in a semen specimen, cultures should be done.
Causes of Male Infertility
- Abnormalities in the semen parameter
- Abnormalities in the seminal fluid
- Hormonal Abnormalities
- Infections
- Problems with the Ductal system-Obstructive Azoospermia
- Drugs can cause Ejaculatory Dysfunction
- Difficulties with erections and ejaculation
- Drugs that causes decrease in sperm count
- Cryptorchidism
- Testicular Failure