Male Infertility

What is Male Infertility?

When a couple fails to achieve pregnancy after about 1 year of regular, unprotected intercourse, male infertility may be the reason. About half of the infertility problems in the United States are attributed to the male.

Causes of Male Infertility

Some of the factors that cause male infertility include:

• varicocele
• a mass of dilated and tortuous varicose veins in the spermatic cord
• semen disorders. such as volume or motility disturbances or inadequate sperm density
• proliferation of abnormal or immature sperm with variations in the size and shape of the head
• systemic disease, such as diabetes mellitus, neoplasms, hepatic and renal diseases, and viral disturbances, especially mumps orchitis
• genital infections. such as gonorrhea and herpes
• disorders of the testes, such as cryptorchidism, Sertoli-cell-only syndrome, and ductal obstruction (caused by absence or ligation of vas deferens or infection)
• genetic defects, such as Klinefelter's syndrome (chromosomal pattern XXY, eunuchoidal habitus, gynecomastia, and small testes) or Reifenstein's syndrome (chromosomal pattern 46, XY, reduced testosterone, azoospermia, eunuchoidism, and hypospadias)
• immune disorders, such as autoimmune infertility
• endocrine imbalance that disrupts pituitary gonadotropins, inhibiting spermatogenesis, testosterone production, or both (occurring in Kallmann's syndrome, panhypopituitarism, hypothyroidism, and congenital adrenal hyperplasia)
• chemicals and drugs that can inhibit gonadotropins or interfere with spermatogenesis, such as arsenic, methotrexate, medroxyprogesterone, nitrofurantoin, monoamine oxidase inhibitors, and some antihypertensives
• sexual problems, such as erectile dysfunction, ejaculatory incompetence, or low libido
• other factors, such as age, trauma to the testes, and alcohol or marijuana use.

Signs & Symptoms of Male Infertility

Male infertility occurs when the man's partner does not conceive after one year of attempting to become pregnant.

Diagnostic tests

The most conclusive test for male infertility is semen analysis. Other tests include gonadotropin assay to determine the integrity of the pituitary gonadal axis; serum testosterone evaluation to determine end-organ response to luteinizing hormone(LH); urine 17-ketosteroid levels to measure testicular function; and testicular biopsy to clarify unexplained oligospermia and azoospermia. Vasography and seminal vesiculography may also help.

Treatment

Infertility resulting from anatomic dysfunction or infection requires correction of the underlying problem. A varicocele requires surgical repair or removal. Patients with sexual dysfunction need education, counseling, or special therapy. Decreased follicle-stimulating hormone may respond to vitamin B therapy. Decreased LH levels may respond to chorionic gonadotropin. Normal or elevated LH requires low dosages of testosterone. Low testosterone levels, decreased semen motility, and volume disturbances may respond to chorionic gonadotropin.

Patients with oligospermia who have a normal history and physical examination, normal hormonal assays, and no Signs of systemic disease require emotional support and counseling, adequate nutrition, multivitamins, and selective therapeutic agents, such as clomiphene, chorionic gonadotropin, and low doses of testosterone. Alternatives to such treatment are adoption and artificial insemination.

Prevention Tips

Some common cases of male infertility may be avoided by doing the following:

• Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.
• Avoid drugs and medications known to cause fertility problems.
• Avoid excessive exercise.
• Eat a diet with adequate folic acid.
• Have regular physical examinations to detect early Signs of infections or abnormalities.
• Practice safer sex to avoid sexually transmitted diseases.