Infertility in Men
Infertility in Men: Description, Causes, and Risk Factors:
The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the egg's DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The midpiece contains the mitochondria which supply the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm has to reach the uterus and the fallopian tube in order to fertilize a woman's egg.
Male Infertility in Men depends on the proper function of a complex system of organs and hormones: The process begins in the area of the brain called the hypothalamus-pituitary axis, a system of glands, hormones, and chemical messengers called neurotransmitters, all of which are critical for reproduction. The first step in fertility is the production of gonadotropin-releasing hormone (GnRH) in the hypothalamus, which prompts the pituitary gland to manufacture follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH maintains sperm production, and LH stimulates the production of the male hormone testosterone. Both sperm and testosterone production occurs in the two testicles, or testes, which are contained in the scrotal sac (the scrotum).
Causes of Infertility in Men:
- Smoking - significantly decreases both sperm count and sperm cell motility.
- Chronic alcohol abuse.
- Anabolic steroid use - causes testicular shrinkage and infertility.
- Overly intense exercise - produces high levels of adrenal steroid hormones which cause a testosterone deficiency resulting in infertility.
- Inadequate vitamin C and Zinc in the diet.
- Tight underwear--increases scrotal temperature which results in decreased sperm production.
- Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, benzene, boron, and heavy metals.
- Malnutrition and anemia.
- Excessive stress.
- Hyperprolactinemia: Elevated Prolactin-Greater elevations of the hormones may result in reduced sperm production, reduced libido and may result in impotence.
- Hypothyroidism: Low thyroid hormone levels may cause reduction of quality of semen, poor testicular function and may disturb libido. This may be caused due to a diet high in iodine.
- Adrenal Hyperplasia: This condition occurs when the pituitary is suppressed by increased levels of adrenal androgens. Symptoms for this include low sperm count, an increased number of immature sperm cells, and low sperm cell motility.
- Hypogonadotropic Hypopituitarism: Low pituitary gland output of LH and FSH. This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and testosterone producing cells to deteriorate.
- Panhypopituitarism: Complete pituitary gland failure-This condition lowers growth hormone, thyroid-stimulating hormone, and LH and FSH levels. Symptoms include: lethargy, impotence, decreased libido, loss of secondary sex characteristics, and normal or undersized testicles.
- Varicocele: This is an enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart) and are present in 15% of the general male population and 40% of infertile men.
- Damaged Sperm Ducts: Seven percent of infertile men cannot transport sperm from their testicles to out of their penis.
- Torsion: It is a common problem affecting fertility that is caused by a supportive tissue abnormality which allows the tests to twist inside the scrotum and is characterized by extreme swelling.
- Infection and Disease: Mumps, TB, Brucellosis, gonorrhea, typhoid, influenza, smallpox, and syphilis can also cause testicular atrophy.
- Klinefelter's Syndrome: Is a genetic condition in which each cell in the human body has an additional X chromosome--men with Klinefelter's Syndrome have one Y and two X chromosomes. Physical symptoms include peanut-sized testicles and enlarged breasts.
- Retrograde Ejaculation: Is a condition in which semen is ejaculated into the bladder rather than out through the urethra because the bladder sphincter does not close during ejaculation.
The most common symptom of infertility in men is a low count of sperm and poor quality of sperm. Around 90% of men who have infertility problems suffer it due to lower sperm count. According to the recently published data of WHO, it is concluded that the normal sperm count is over 15 million sperm per milliliter. Oligozoospermia is the medical term used for the low sperm count. There is only a few physical examination that determines and pinpoint the exact reason for infertility.
- The inability to conceive a child.
- Problems with sexual function — for example, difficulty reaching orgasm (delayed ejaculation) or difficulty maintaining an erection (erectile dysfunction).
- Pain, swelling or a lump in the testicle area.
- Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality.
The patients will provide the doctor with a detailed history of any medical or sexual factors that might affect fertility:
- Frequency and timing of sexual intercourse.
- Duration of infertility and any previous fertility events.
- Childhood illnesses and any problems in development.
- Any serious illness (diabetes, respiratory infections, cancer, previous surgeries).
- Sexual history, including any sexually transmitted diseases (STDs).
- Any exposure to toxins, such as chemicals or radiation.
- History of any medications and allergies.
- Any family history of reproductive problems.
A physical examination of the scrotum, including the tests, is essential for any male fertility work-up. It is useful for detecting large varicoceles, undescended testes, the absence of vas deferens, cysts, or other physical abnormalities.
The basic test to evaluate a man's fertility is a semen analysis. The sperm collection test for men who can produce semen involves the following steps:
- A man should abstain from ejaculation for several days before the test because each ejaculation can reduce the number of sperm by as much as a third. To ensure an accurate sample, most doctors recommend abstaining from ejaculation for at least 2 days, but not more than 5 days, prior to semen collection.
- A man collects a sample of his semen in a collection jar during masturbation either at home or at the doctor's office. Proper collection procedure is important since the highest concentration of sperm is contained in the initial portion of the ejaculate. Specially designed condoms are also available that enable collection of a sample during sexual intercourse.
- The sample should be kept at body temperature and delivered promptly. If the sperm is not analyzed within 2 hours or kept reasonably warm, a large proportion may die or lose motility.
- A semen analysis should be repeated at least three times over several months.
Blood Tests: Blood tests are used for measuring several factors that might affect fertility:
- Hormonal Levels: Tests for certain hormone levels are indicated if semen analysis is abnormal (especially if sperm concentration is less than 10 million per milliliter) or there are other indications of hormonal disorders.
- Blood tests for testosterone and follicle-stimulating hormone (FSH) levels are usually taken first. If testosterone levels are low, then luteinizing hormones (LH) are measured. Low levels of FSH, LH, and testosterone indicate a diagnosis of hypogonadotropic hypogonadism. Very high FSH levels with normal levels of other hormones indicate abnormalities in initial sperm production. Usually, this occurs only if the testicles are severely defective, causing Sertoli cell-only syndrome, in which sperm-manufacturing cells are absent. Other hormones, such as prolactin, estrogen, or stress hormones may be measured if there are symptoms of other problems, such as low sexual drive or the presence of breasts.
- Blood tests can also determine the presence of any infections that might affect fertility, including HIV, hepatitis, and Chlamydia.
Genetic Testing: Genetic testing may be warranted in men who are severely deficient in sperm and who show no evidence of obstruction, particularly in men undergoing the intracytoplasmic sperm injection (ICSI) procedure. Genetic testing can help to identify DNA fragmentation, chromosomal defects, or the possibility of genetic diseases that can be passed on to children. If genetic abnormalities are suspected in either partner, counseling is recommended.
Treatment of male infertility depends on the cause, how long you've been infertile, your age and personal preferences. In all cases of infertility, the female partner also will need to be checked and may need treatment. In some cases, treatment of the female partner can compensate for male fertility problems. Your doctor may try to improve your fertility by either correcting an underlying problem or trying treatments that seem like they may be helpful. Often, an exact cause of infertility can't be identified. Even if an exact cause isn't clear, your doctor may be able to recommend treatments that work.
Treatment Options May Include:
- Sexual Issues: In this case doctors help men deal with impotence or premature ejaculation through behavioral therapy and/or medicines.
- Antibiotics also are used to clear up infections affecting sperm count.
- Too few sperm: In such cases the main cause of the problem can be treated through surgery.
- Sperm movement: Sometimes blockage in Man's System results in no sperm in semen. Surgery is one of the options to correct the problem.
- In vitro, fertilization/intracytoplasmic sperm injection are advanced techniques to help deal with poor sperm count and motility.
- Problems like varicocele can often be surgically corrected or an obstructed vas deferens can be repaired.
Supplements that show some promise for improving sperm count or sperm quality include:
- Vitamin C.
- Vitamin E.
- Vitamin B-12.
- Asian ginseng.
Other supplements — including L-arginine and L-carnitine — may help improve sperm quality, but more research is needed.
Talk to your doctor before taking any herbal remedies or supplements, as some can cause harm when taken in high doses (megadoses) and some can cause problems when taken with certain medications.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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