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Male Infertility Issues
Male infertility is a term that irefers to in respect nfertility in male humans.
Male infertility is involved in a sexually paired couple’s inability to envisage in a significant number of cases, with estimates ranging from 40-50%.
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
o Abnormal sperm morphology
o oligospermia
o Azoospermia (complete lack of sperm in semen, can be due to scar tissue in testicle)
Factors that, in turn, affect basically the semen quality include:
• 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]
• Genetic defects on the Y chromosome
o Y chromosome microdeletions
• Abnormal set of chromosomes
o Klinefelter syndrome
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 actually 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 the 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 exactly , 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 total duration of infertility, earlier pregnancies with present or to 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), other 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).
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 disclose 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 vital 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 to androgen deficiency.
The scrotal contents should be cautiously palpated with the patient standing. As it is often psychologically uncomfortable for men to being examined, one helpful hint is to make the examination as well-organized and as matter of fact as possible.
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