Male Infertility

Male infertility accounts for 30-40% of infertility. Male infertility is usually related to abnormal sperm production or function. Problems can occur anywhere in the production of sperm including hormonal regulation, storage, and transport of sperm. Genetic abnormalities can also contribute to decreased sperm or abnormal function. Fortunately, there are treatments that can help improve a couple’s chances of becoming pregnant. Intrauterine insemination (IUI), IVF and Intracytoplasmic Sperm Injection (ICSI) are the most commonly performed procedures for male infertility. Other treatments include treatment of medical and endocrine problems, surgical correction of varicocele, vasovaostomy in vas deference blockage and vasectomy reversal in vasectomized patient.

Causes of male infertility:

  • Oligospermia : When sperm count is less than 20 million per ml.
  • Asthenospermia: When motility of sperm is less than 50% and fast forward movement is less than 25%.
  • Teratospermia: When more than 70% sperm are morphologically abnormal.
  • Oligoasthenoteratospermia (OATS): Combination of all three.
  • Azoospermia: When there is no sperm in semen.
  • Impotence: When some one is incapable to perform coitus.
  • Retrograde ejaculation: When all semen enter into the urinary bladder due to some defect in bladder neck.
  • Unexplained: When there is no specific cause of infertility.
  • Aspermia: When there is no ejaculate or there is no semen.

Physiology:

Sperm production is regulated by hormones called gonadotropins. These hormones include follicle stimulating hormone (FSH) and lutenizing hormone (LH). FSH is mostly responsible for sperm production, whereas LH is mostly responsible for testosterone production. These hormones can be evaluated for abnormalities which cause inadequate sperm production. Excessive testosterone or other androgens such as DHEA can cause a reduction in sperm production by decreasing circulating levels of FSH and LH. Men should avoid supplements containing unknown substances, especially androgen containing supplements. In addition to supplements, hormonal imbalances may result from effects of other hormones in the body. Prolactinomas (pituitary tumors that secrete prolactin) and thyroid abnormalities can also lead to abnormalities in sperm production. Transient events such as illness and infections may also alter the hormonal regulation of sperm. These effects are usually temporary and resolve with time.

Anatomy:


Hormones stimulate the production of sperm within the testicle. As the sperm matures, they are moved towards collecting tubules which allow passage of the mature sperm to the storage area known as the epididymis. The sperm remain there until they are broken down or ejaculated. Ejaculated sperm traverses a tube known as the vas deferens. The vas deferens passes through the prostate gland where the sperm is mixed with additional fluid from the seminal vesicle. The sperms then enter in the urethra and out the opening of the penis. Obstructions or anatomical abnormalities along this pathway can lead to male infertility.

Physical abnormalities:

Physical abnormalities that can lead to male infertility include problems with the testicles, vas deferens, and prostate. Testicular death (atrophy) or cryptorchoidism (non-descended testicle) can happen spontaneously or be associated with chromosomal abnormalities. Excessive dilation of the blood vessels around the testicle known as a varicocele can lead to excessive heating of the testicle and cause problems with the sperm. In men with congenital absence of the vas deferens (CAVD), the tube carrying sperm to the penis is absent. This condition has a high association with cystic fibrosis. The tubes and other anatomy of the male reproductive tract may also be blocked due to scar tissue from infections or previous surgery. Prostatitis, an infection of the prostate gland, can lead to high white blood cell counts and an altered acidity (pH) of the semen. This can have an effect on sperm function and survival. Less commonly, the testes do not produce any sperm due to cellular abnormalities of the testicle.