Infertility in Males

Male Factor Infertility

In order to impregnate an egg, several physical elements must work together. You must have at least one functioning testicle that produces healthy sperm. Enough sperm must be carried into the semen and then mix with the semen. The semen must be ejaculated in order to fertilize your partner’s egg. When all the right criteria are met, conception may occur.

At times, this natural process is disrupted by disorders and medical issues that prevent fertilization. According to studies, male factor problems account for 30% of infertility. Many men struggle with a wide variety of fertility issues and rely on Premier Fertility Center for help.

Common Causes of Infertility

Understanding reasons why male infertility may occur is a first step toward a solution.

  • Excessive exercise which can release high amounts of steroid hormones
  • Taking testosterone over-the-counter androgens, such as DHEA for weight training.
  • Heat from clothing that constricts, frequent bike riding, saunas, hot tubs, and hot baths
  • Stress
  • Obesity
  • Inadequate sleep
  • Inadequate nutrition
  • Exposure to pesticides, lead, mercury, radiation, radioactive substances, heavy metals
  • Use of drugs that can work against healthy sperm, such as marijuana, cocaine, tobacco and overuse of alcohol (more than two drinks daily).

Primary Testicular Disorders

Problems at the testicular level can cause infertility, as follows:

  • Spermatogenesis is the process in which spermatogonia development into mature spermatozoa. Cryptorchidism or undescended testes, if not treated properly in early life through hormonal and/or surgical treatment, may prevent spermatogenic capacity.
  • Physical and chemical agents can affect spermatogenesis, such as irradiation of the testes, the use of cytotoxic drugs, cimetidine (which competitively inhibits androgens), sulphasalazine (reversible on discontinuation), and spironolactone (which blocks androgen receptors).
  • Spermatogenesis is also inhibited by acute and chronic heavy metal poisoning (e.g. lead, arsenic, zinc, mercury), accidental inhalation of insecticides (1,2 dibromo-3-chloropropane, DBCP), herbicides (paraquat) or sterilization gas (ethylene oxide).
  • Immunological disorders may cause antibodies to inhibit spermatogenesis and attack sperm. Antisperm antibodies may be produced following infection or trauma to one or both testicles and in patients who had reversal of sterilization after a lengthy time lapse.
  • Varicocele is a mass of varicose veins in the spermatic cord. It is thought that the presence of a varicocele leads to an increased temperature of the testes and a suppressing effect on spermatogenesis. The optimum temperature for spermatogenesis is 29-35 °C and this is achieved by the extra-abdominal location of the testes. However, the relation between varicoceles and male infertility has been challenged (Vermeulen and Vandeweghe, 1984; Baker et al, 1985).
  • Chronic illness and general ill health, such as diabetes, hypothyroidism, malignancies and other debilitating diseases, may lead to deranged spermatogenesis.
  • Sperm immotility (lack of movement) can occur due to absence of dynein arms in the sperm tail. This occurs in some disorders including the Kartagener syndrome where the motility of all body cilia is impaired, leading also to sinusitis and bronchitis.
  • Sperm motility is also inhibited by the use of propranolol and other beta blockers, nitrofuranes, niridazole (an antischistosomal) and ethanol (which produces relative deficiency of vitamin A).
  • Chromosomal disorders can cause infertility, such as Klinefelter Syndrome in which the cells contain 47 chromosomes (44 autosomes and XXY sex chromosomes).
  • Genetic problems may cause infertility.
  • Orchitis is an inflammation of the testicles (traumatic and infective). In particular, mumps occurring in adult males may lead to permanent testicular damage. A vasectomy, an infection, or an injury to the testicles can cause infertility.
  • Cancer treatment with certain kinds of chemotheraphy or radiation can cause infertility.
  • Drug use (including marijuana, tobacco, alcohol and some prescription medications) may cause infertility.
  • Hormonal problems of the testicles or pituitary gland may cause infertility.
  • An idiopathic group remains in which no specific cause for the testicular disorder can be found.

Obstruction

  • The excretory ducts of the male genital system may be at fault, despite the presence of a normally functioning hypothalamic pituitary testicular axis. The obstruction may be congenital or may follow chronic infection.
  • Structural problems, such as blocked ejaculation due to a surgical vasectomy, can affect fertility.
  • An absence of a vas deferens (a birth defect that may be associated with the cystic fibrosis gene) is another structural problem.
  • Retrograde ejaculation (the ejaculation of semen into the bladder rather than out through the penis) is also a structural problem.
  • Accessory Gland Disorders may be due to congenital absence of the vas and/ or seminal vescicles or due to chronic infection (i.e. prostatitis or seminal vesiculitis) leading to an increased number of WBCs and other inflammatory cells. The semen contains debris and pus cells which may affect the normal function and motility of the spermatozoa.

Low Semen Parameters

If you are experiencing symptoms of male infertility, the first thing you should do is see a specialist, typically a reproductive endocrinologist or urologist. After a physical examination, the specialist will probably order a semen analysis, which will check the quality and quantity of the sperm in the semen. He or she will want you to give the sample in the office, since it is important that the analysis take place as soon as possible. Please remember, as self-conscious as you might feel, a semen analysis is a commonplace test and the results could save you months of worry and stress.

If the first semen analysis is normal, your doctor may order a second test to confirm the results. Two normal tests usually indicate that you do not have any significant infertility problems. If something in the results appears irregular, your doctor might order further tests to pinpoint the problem.

  • The most common cause of male factor infertility is low sperm count. Male and laboratory evaluation can reveal reasons for low semen parameters. A semen analysis can determine whether male infertility is caused by a low or absent sperm count.
  • A less common cause of infertility is absence of sperm in the semen. This affects only 1 percent of all men and 10 to 15 percent of infertile men.

Vasectomy and Sperm Extraction

Men who have had a vasectomy may be candidates for sperm extraction, also known as testicular sperm aspiration (TESA) and intracytoplasmic sperm injection (IVF/ICSI). The procedure involves sperm retrieval from the dissection of the testicle, epididymis or vas deferens. It is performed under local anesthesia in conjunction with the egg harvesting of a female partner.

Men who have little or no sperm, are unable to ejaculate, or have spinal cord injuries may also be TESA candidates.