Main Causes of Male Infertility

Testicular insufficiency (insufficient function of the testicles)

  • Cryptorchidism – disorder of testicular descending and its development
  • Orchitis – inflammation of the testicles
  • Testicular torsion – spermatic cord to the testicle is twisted or cut off, such as due to an injury
  • Chemotherapy or radiation therapy for oncological diseases
  • Genetic causes (Klinefelter syndrome, absence of Y chromosome)

Hormonal disorders – there are many different types, for example

  • Kallman syndrome – isolated failure of FSH and LH hormone secretion combined with loss of the sense of smell
  • Hypophysis diseases – tumors, infections

Obstructions of the Male Genital Tract (Blockage)

  • Congenital
  • Prostate cysts
  • Obstructions of epididymis (congenital, infectious)

Spermatic antibodies

  • Medication, living environment, stress
  • Global varicocele disease (vascular)
  • Expanded veins (varixes) in scrotum
  • Sexual problems (inability to ejaculate)
  • Idiopathic disorders – undiagnosable, unclear

Additional male examinations include

Lifestyle factors, such as alcohol, anabolic steroids or excessive sport activity, can sometimes be responsible for a decrease in sperm quality. Higher temperatures, such as frequent sauna visits or hot baths or just normal exposure to hot temperatures, also affect spermatogenesis. Taking substantial amounts of medication can also be a factor.

Male factors contribute to 40% of all infertility cases.

According to the current criteria, a normal male has more than 15 million sperm cells in 1 ml of sperm.

Sperm cell count can be lower, which decreases the chance of conceiving from a sexual intercourse.

In 1938, the male’s average sperm contained 120 million/ml sperm cells. Scientific studies from 1952 show average values of only 73. 4 million/ml. Similar studies from 1972 show only 54. 4 million/ml.

Sperm quality has been decreasing very rapidly in the last decade, especially in industrial countries. 

Male factors contribute to 40% of all infertility cases. Semen analysis is the basic examination of male fertility. If semen analysis shows fundamental deviations from normal levels an examination by an andrologist is indicated. The diagnosis of male infertility focuses on more frequent disorders, such as testicular and epididymal abnormalities, varicocele, or abnormalities of the prostate gland and vesiculae seminales. An examination of the partner is necessary even if the male examination shows abnormal results.

Treatment of Male Infertility 

Medication (Hormonal) Treatment

To this day, no scientific study has shown that hormonal therapy, such as therapy with human menopausal gonadotrophin (HCG), human chorionic gonadotrophin (hCG), androgens, antiestrogens (clomiphen, tamoxifen ), prolactin inhibitors (bromocriptine) and steroids, leads to better chances of conceiving for men with oligoasthenoteratospermia (general abnormality of the sperm) with unclear source. However, some primary endocrinologically based pathologies can be treated by medications.

Low testosterone levels can be an indication for testosterone therapy. Higher-than-normal testosterone levels can also negatively affect spermatogenesis. Corticosteroid therapy is sometimes used, but patients with spermatic antibodies are not treated this way because of the serious side effects and a lack of proven effectiveness.

Surgical Treatment

Varicocele

Successful surgical performance leads to an increase in sperm quality in 44% of tested men.

MESA

The MESA method combined with ICSI is indicated in case of azoospermia (no sperm cells present in the ejaculate). If the MESA method does not prove successful in gathering sperm cells (spermatozoa) or a very small amount is gathered, a testicular sperm extraction (TESE) can be performed and the gathered sperm can be used for IVF – ICSI.

The Evolution of Male Infertility

According to the current criteria, a normal male has more than 15 million sperm cells in 1 ml of sperm. Sperm cell count can be lower, which decreases the chance of conceiving from a sexual intercourse. In 1938, the male’s average sperm contained 120 million/ml sperm cells. Scientific studies from 1952 show average values of only 73. 4 million/ml. Similar studies from 1972 show only 54. 4 million/ml.

Sperm quality has been decreasing very rapidly in the last decade, especially in industrial countries. US experts are suggesting a 1. 5% decrease each year. The data also show declining trend of male fertility in developed countries. Assisted reproduction (in-vitro fertilization, IVF), most commonly the Intra Cytoplasmic Sperm Injection (ICSI) method or its modifications (IMSI, PCSI), is the most widely used treatment method in cases of infertility caused by low sperm count or quality.

Sexual Dysfunction

Ejaculation disorders

Retrograde ejaculation (backwards ejaculation) or anejaculation (inability to ejaculate) can be caused by:

  • neurological disease – prostate or urethra injury
  • antidepressant therapy

The cause of retrograde ejaculation is often undetected. The diagnosis is then determined by anamnestic and laboratory data and a urine examination after ejaculation. Retrograde ejaculation can be partial – even very small amounts of ejaculate can be ejected backwards. Retrograde ejaculation treatment is focused on the causes of the disease; sperm cells from urine after ejaculation can be used in assisted reproduction. Anejaculation can be prevented by vibrostimulation or electroejaculation. Ejaculation can be induced in about 90% of patients with spinal cord injuries, but the sperm quality is usually low with small amount of motile sperm cells. This explains low success rates of intrauterine insemination treatment of couples with anejaculation. IVF – ICSI methods are often necessary.

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