Male Infertility

Infertility is on the rise and the male component seems to be paralleling the female counterpart. Infertility impacts one of every six couples attempting pregnancy or may be even earlier.
The male partner contributes in 30-50% of cases and is the sole factor in up to 20%.
Therefore, semen analysis remains the mainstay of male infertility assessment. But men with normal semen profiles are not necessarily fertile, which can be due to abnormal sperm DNA.

Classification of Male infertility Factors

Anatomical factors,
Endocrine factors,
Genetic factors,
Immunological factors,
Mechanical damage,
Ejaculatory dysfunction,
Neurological impairment,
Psychological dysfunction.

1) Anatomical factors

Varicocele: An enlargement of the veins within the scrotum. It may develop as a result of poorly functioning valves that are normally found in veins.
Cryptorchidism: A condition in which one or both of the testes fail to descend from the abdomen into scrotum.
Congenital anomalies:

1)Hypospadias: A condition in which the opening of the penis is on the underside rather than the tip. It is more common in infants with a family history of hypospadias.
2)Epispadias: It is characterized by the failure of the urethral tube on the dorsal aspect.

2) Endocrine factors

Cushing’s syndrome: A condition that occurs from exposure to high cortisol levels for a long time.
Acromegaly: A disorder in adults in which the pituitary gland produces too much growth hormone.
Pituitary tumor: The pituitary gland is below the brain and above the nasal passages. A large tumor can press upon and damage the brain and the nerves.

3) Genetic factors causing male infertility

The genetic factors involved in male infertility are:

Chromosomal disorders,
Mitochondrial DNA (mtDNA) mutations,
Y chromosome deletions,
Multifactorial disorders,
Imprinting disorders.

4) Infection

Gonorrhea: A sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.
Prostatitis: Swelling of the small walnut-sized gland that produces seminal fluid.
Epididymitis: Inflammation of the tube at the back of the testicle that stores and carries sperm.

5)Idiopathic causes of male infertility

Idiopathic male infertility is known as Oligoasthenoteratozoospermia.
It indicates that the men have an unexplained reduction of semen quality.
It nearly affects 10-15% of men in their prime reproductive age.
More than 500 gene were postulated to be associated with this disease condition.

6) Immunological factors

Sperm antibodies: Sperm antibodies that fight against a man’s sperm in blood, vaginal fluids or semen.

7) Mechanical damage

  • Spinal injuries,
  • Diabetes,
  • Medications,
  • Surgery of the bladder,
  • Surgery of the urethra,
  • Surgery of the Prostate gland,
  • Accidents,
  • Herniation,
  • Nerve damage,
  • Long term sickness.

8) Ejaculatory dysfunction causes male infertility

Premature ejaculation: Emission of semen occurring just before or shortly after beginning sexual intercourse.
Retrograde ejaculation: Defined as passage of seminal fluid from the posterior urethra into the bladder instead of distal urethra.
Anejaculation: Inability of a man to have an ejaculation.

9) Neurological Impairment

Neurological defects in men causes infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities.

10)Psychological dysfunction

Feeling of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which increases the feeling of inadequacy that already accompany infertility.

Other causes include:

  • Smoking,
  • Alcohol,
  • Stress,
  • Occupational exposure,
  • Lifestyle factors,
  • Exposure to radiation,
  • Chemotherapy
  • Sexually transmitted diseases
  • Recreational drugs
  • Opioids, Heroin etc.

Treatment of male infertility

Vibratory stimulation: Is applied to the underside of the glans penis and vibrates at a designed frequency and wave amplitude. This stimulation travels via the sensory nerves to the spinal cord and induces a reflex ejaculation.
Electroejaculation: It includes electrical stimulation of the sympathetic efferent fibres. It is performed under general anaesthesia. Voltage is gradually raised till ejaculation occurs.

Hormonal treatment:

Gonadotropin-releasing hormone.
Dopamine agonist.
Aromatase inhibitor therapy.
Selective oestrogen receptor modulators.

Surgical sperm extraction

TESA: Testicular epididymal sperm aspiration.
PESA: Percutaneous epididymal sperm aspiration.
MESA: Microsurgical epididymal sperm aspiration.
TESE: Testicular epididymal sperm extraction.
Micro-TESE: Micro surgical Testicular epididymal sperm extraction.

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