Male infertility accounts for 15% of infertility cases. Also male infertility may contribute to 30-40% of all infertility instances. Because of this, couples who cannot get pregnant should apply to the clinic together. Couples who are unable to get pregnant after 1 year of unprotected, timed intercourse are regarded as infertile. When one partner is over 35, then they can consider being evaluated for infertility sooner than one year.
Male Infertility Reasons:
- Environmental – working conditions. Wearing tight pants, truck drivers, window workers, bakers. In working environments where the testes are subjected to high heat, the testes’ sperm production may be compromised.
- Undescended testis. Men who have bilateral undescended are infertile.
- Sexual and psychological
- Infections: Gonorrhea, Tuberculosis, Chlamydia micoplasma and ureoplasma infections usually cause blockage in the sperm collecting ducts causing infertility. Irreversible infertility is often caused by viral infections like Mumps that affect both testes.
- Systemic infections (kidney and liver disease)
- Trauma (physical injury)
- Tumors in testes. Drugs used for cancer therapy and radiotherapy will decrease sperm production.
When evaluating for infertility, semen analysis is the first test that must be done. In order to standardize the results, 2-4 days sexual abstinence is recommended.
In the event that the results of the semen analysis are sub-normal, the test must be repeated one month later. If the second test also shows sub normal results, then a physical exam and blood tests will be required.
The doctor will examine the penis, opening of the urethra, testes, epidydimis, and prostate. The patient’s body type, hair growth, genitalia will be examined in detail. Sexual functions, erection – ejaculation and other habits that might result in infertility will also be evaluated. Items below are also shown to cause infertility.
- Drinking excessive alcohol
- Illegal drug use
- Chemotherapy ( cancer drugs)
- Testes being exposed to heat for prolonged periods of time
The doctor can discern the congenital absence of the vasa deference (CAVD) during the physical exam. Vasa deference is the sperm carrying tube that moves sperm from the testes to the urethra. The possibility of a genetic disease called Cystic Fibrosis must be investigated in patients when CAVD is observed.
If testes are smaller than normal then genetic diseases maybe the cause. Kleinfelter’s syndrome is a genetic condition where there genetic composition is 47, XXY and is characterized by small testicles. These patients do not have sperm in their ejaculate but tissue biopsied from the testicles can contain sperm. When there are abnormalities in secondary sexual characteristics such as body hair, sexual dysfunction, hormonal problems such as hypogonatrophic hypoganadism should be investigated. Cryptorchidism (undescended testicles): Testicles descend into the scrotum at birth or one year after the birth at the latest. The condition where one or both testicles have not descended into the scrotum is called Cryptorchidisim. Testicles that remain in the abdomen are exposed to prolonged heat which breaks down sperm production. Infertility is only caused by bilateral cryptorchidisim.
Varicocele: Caused by incompetent valves in the blood vessels around the testicles and like varicose veins in the legs, the veins in the testicles expand. Sperm production is negatively affected by the reduced blood circulation and increased heat in the testicles. Some people may need surgery to correct the condition. Hormone tests are required if semen analysis is sub normal or if the patient has other endocrinological disorders such as diabetes. FSH and Testosterone are the most commonly tested hormones. More detailed tests will be done if necessary.
FSH may appear to be normal in some patients with abnormal spermatogenesis. But an increased level of FSH in the serum is a sign of abnormal spermatogenesis. Some patients may have their urine checked for the presence of sperm right after ejaculation. Ultrasonography, the antisperm antibody test, cervical mucous interaction test are some of the more detailed tests they may be done on semen and sperm.
When looking at semen under a microscope, leukocytes and immature germ cells are difficult to tell apart. These cells are labeled round cells. Many laboratories evaluate all the round cells as leukocytes and report them as such.
In such cases, doctors will evaluate the genital tract for infection. Immunological tests also need to be done to determine whether the round cells observed are immature germ cells or leukocytes.