Infertility, Male

Male infertility may be suspected whenever a couple fails to achieve pregnancy after about 1 year of regular unprotected intercourse. About 40% to 50% of infertility problems in the United States are totally or partially attributed to the male.

Causes

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, liver and kidney diseases, and viral disturbances, especially mumps orchitis
• genital infection. such as gonorrhea, tuberculosis, and herpes
• disorders of the testes, such as cryptorchidism, Sertoli-cell-only syndrome, varicocele, and ductal obstruction (caused by absence or ligation of the vas deferens or infection)
• genetic defects, such as Klinefelter's syndrome (chromosomal pattern XXY, eunuchoidal habitus, gynecomastia, small testes) or Reifenstein's syndrome (chromosomal pattern 46XY, reduced testosterone, azoospermia, eunuchoidism, gynecomastia, hypospadias)
• immune disorders, such as autoimmune infertility and allergic orchitis
• endocrine imbalance (rare) that disrupts pituitary gonadotropins, inhibiting spermatogenesis, testosterone production, or both; such imbalances occur 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 acetate, nitrofurantoin, monoamine oxidase inhibitors, and some antihypertensives
• sexual problems, such as erectile dysfunction, ejaculatory incompetence, and low libido.

Other factors include age, occupation, trauma to the testes, and tight-fitting clothing that constricts the scrotum and affects sperm production.

Signs and symptoms

The obvious indication of male infertility is failure to impregnate a fertile woman. Clinical features may include:

• atrophied testes
• empty scrotum
• scrotal edema
• varicocele or anteversion of the epididymis
• inflamed seminal vesicles
• beading or abnormal nodes on the spermatic cord and vas deferens
• penile nodes, warts, or plaques or hypospadias
• prostatic enlargement, nodules, swelling, or tenderness.
  

In addition, male infertility is often apt to induce troublesome negative emotions in a couple, such as anger, hurt, disgust, guilt, and loss of self-esteem.

Diagnosis

Investigating suspected infertility requires a number of tests for both the man and his partner. Diagnosing male infertility may involve:

• Semen analysis - a sample of the man's semen is investigated in the laboratory and checked for abnormalities and the presence of antibodies.
• Blood tests - to assess hormone levels.
• Testicular biopsy - a fine needle and microscope are used to check the network of tubes to see if there are any sperm in them.
• Ultrasound test - to take pictures of the reproductive organs, such as the prostate gland.

Treatment

When anatomic dysfunctions or infections cause infertility, treatment consists of correcting the underlying problem. A varicocele requires surgical repair or removal.

For patients with sexual dysfunctions, treatment includes education, counseling or therapy (on sexual techniques, coital frequency, and reproductive physiology), and proper nutrition with vitamin supplements.

Decreased follicle-stimulating hormone levels may respond to vitamin B therapy; decreased LH levels may respond to chorionic gonadotropin therapy. A normal or elevated LH level requires low dosages of testosterone. Decreased 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 assay results, 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 dosages of testosterone. Obvious alternatives to such treatment are adoption and artificial insemination

Prevention

Most types of male infertility aren't preventable. However, avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility. Also, high temperatures can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.

If you're a man who's uncertain about whether you would eventually like to become a father, don't undergo permanent sterilization, such as a vasectomy. Although surgery to reverse this condition is possible, risks are involved that could affect fertility in other ways.