Male Infertility is due to low sperm production, abnormal sperm function, or blockages that prevent the provision of sperms.
For ages, Infertility has long been considered a woman’s problem. But as it turns out, an estimated 15% of couples are considered infertile, with approximately 35% due to female factors alone, 30% due to male factors alone, 20% due to a combination of female and male factors, and 15% unexplained.
A diagnosis of male infertility can be one of the toughest challenges a man can face. For some, it can be devastating. Not being able to father a child can make a man feel heartbroken and demoralized.
A man’s fertility normally relies on the quantity and quality of his sperm. Male infertility is due to low sperm production, abnormal sperm function, or blockages that prevent the provision of sperms. Certain Illnesses, injuries, chronic health problems, and lifestyle habits can exert a negative impact on male fertility.
The inability to conceive a child for more than one year of normal and uninterrupted marital relationship could be the only sign that triggers concern about fertility. There may be no other obvious symptoms. Nevertheless, in the presence of an underlying problem such as hormonal abnormality, inherited/genetic disorder, testicular ailment or dilated veins around the testicle, there could be associated symptoms, for example:
Testicular pain or lump.
Difficulty with ejaculation or small volumes of fluid ejaculated decreased desire or difficulty maintaining an erection (erectile dysfunction).
Inability to smell properly.
Abnormal breast enlargement (= male gynecomastia).
Decreased facial or body hair growth.
Abnormal sperm count.
- Medical Problems: the most common of which include:
The most common of which include:
Varicocele: Abnormal dilatation of the veins that drain the testicles. It is the most common reversible cause of male infertility. It can exert a negative impact on the quantity and quality of sperm production. One of the theories behind such impact is the abnormal rise in temperature around the testicles. Surgical management of the Varicocele can improve sperm count and function, and may potentially improve outcomes, especially when associated with assisted reproductive techniques such as in-vitro fertilization or intra-cytoplasmic sperm insemination.
Trauma: Testicular trauma is one of the most common acquired causes of male infertility. The unique position of the testicles outside the abdomen makes it more vulnerable to both thermal and physical trauma.
Infection: Certain reproductive tract infections can have a negative impact on the count and/or quality of sperms. It can also cause scarring that blocks the passage of sperms.
Antibodies that attack sperm: Abnormal immune response which ends up with the human body’s antibodies attacking its own sperms.
Undescended Testicles: During fetal development, one or both testicles may fail to descend from the abdomen into the scrotum (the sac that normally contains the testicles).
Hormone Imbalances: Male Infertility can be due to disorders of the hormonal system controlling sperm production, including the hypothalamus, pituitary, thyroid, and adrenal glands.
Abnormal Ejaculation: Retrograde ejaculation happens when the semen is ejaculated into the bladder with orgasm instead of emerging out of the penile organ. Several health ailments can cause retrograde ejaculation, including diabetes and spinal injuries.
Certain Medications: Cancer treatments (chemotherapy), long-term use of anabolic steroid, and certain antifungal medications can impair sperm production and decrease male fertility.
Chromosomal Abnormalities: Genetic disorders cause abnormal development of the male reproductive organs.
Sexual Dysfunction: These may include difficulty in sustaining and/or maintaining an erection sufficient for intercourse (Erectile Dysfunction).
- Environmental Factors
Industrial Chemicals: Extended exposure to benzenes, pesticides, herbicides, and lead may exert a negative impact on sperm count.
Heavy Metal Exposure: Exposure to lead or other heavy metals also may cause infertility.
Radiation or X-rays: Exposure to radiation can reduce sperm production.
- Lifestyle Habits
Tobacco Smoking: Several pieces of research, backed up by a staunch scientific opinion, have stated that smokers may have a lower sperm count than do those who do not smoke.
Emotional Stress: Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, may negatively affect sperm count.
Illicit Drug Use: Anabolic steroids taken to stimulate muscle strength and growth can cause the atrophy of the testes and decline in sperm production. Abuse of cocaine or marijuana may reduce sperm count and motility also.
Diagnosing potential cause(s) of male infertility may take time, so don’t get discouraged if you do not receive an answer promptly. Testing for male infertility usually begins with a health care provider doing inquiring medical history in details and undergoing a thorough physical examination, to be followed by a semen analysis test:
Your trusted Andrologist will thoroughly inquire about your childhood growth and development; sexual development during puberty; sexual history; past illnesses or infections; past surgeries; medication history; exposure to certain environmental agents (radiation and toxic chemicals); plus any earlier fertility testing.
Usually includes measurement of height and weight, assessment of body fat and muscle distribution and power, an inspection of the skin and hair pattern, and examination of the genitals and breasts. Particular attention is given to clinical assessment for the presence of Varicocele (=dilated veins of the spermatic cord).
This is the core part of the assessment of male infertility. This analysis provides information about the volume of semen and the sperm number, motility, and shape. A man should avoid ejaculation (sex and masturbation) for a minimum of 3 days before providing the semen sample.
Blood tests provide information about the hormones that control the process of sperm production. Testosterone, Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), and Prolactin are the main hormones to be checked.
If any genetic or chromosomal abnormality is suspected, specialized blood tests may be needed to check for absent or abnormal regions of the male chromosomes.
Can detect the presence of testicular Varicocele or other problems in the testicles and supporting structures.
Presence of sperms in urine can indicate your sperm are traveling backward into the bladder instead of outside during ejaculation (= retrograde ejaculation).
Antisperm Antibody Test
This is to detect the presence of antibodies attacking its own sperms, due to an immune-related abnormality.
Sperm contains unique antigens that are not recognized as self by the body’s immune system because of the blood-testis barrier.
Antisperm antibodies may form when the blood-testis barrier is breached because of infection, vasectomy, testicular torsion, cryptorchidism, or testicular trauma. Antibodies that are bound to sperm decrease the sperm’s ability to penetrate the cervical mucus and fertilize the ovum.
Male Infertility: New Treatments, more Pregnancies
The ultimate goal of Male Infertility treatment is to restore a man’s ability to father a child. Even if an exact cause for the infertility is not clear after a thorough assessment, your trusted Andrologist can recommend treatments or procedures to facilitate conception.
The female partner is also recommended to be checked. This can help to determine if she will require any associating specific treatments, or if the couple would want to proceed with assisted reproductive techniques.
Treatments for male infertility are directed to treating the potential cause, and may include:
Surgery: For example, a Varicocele can often be surgically corrected or an obstructed vas deferens repaired. In the case where no sperm can be retrieved in the ejaculate, sperms can be retrieved directly from the testicles through testicular biopsy.
Treating infections: Antibiotic treatment might cure an infection of the reproductive tract.
Management of sexual dysfunction: Medication or counseling can help improve fertility in conditions such as erectile dysfunction.
Assisted reproductive technologies (ART): If the male partner’s semen contains very few sperms, no sperm, abnormal sperm, or sperm with poor motility, assisted reproductive technologies (ART) can often help. These techniques offer hope to some infertile couples who could not achieve pregnancy without them (e.g. IVF and ICSI).
URINARY TRACT OBSTRUCTION
When the urine flow along the urinary tract is impaired for some reason, this is called Urinary Obstruction.
When the urine flow along the urinary tract is impaired for some reason, this is called Urinary Obstruction. It may occur at any point in the urinary tract from the renal calyces in the kidney to the external urethral meatus. Obstruction can be unilateral or bilateral.
Urinary Obstruction can be a presentation of benign or a serious condition. In either case, it has to be brought to medical attention as it may lead to kidney failure if left untreated.
Signs and Symptoms include:
Inability to pass urine (urinary retention).
A weak stream of urine.
Blood in the urine.
Pain in either flank (side) or in the back.
Abdominal pain and/or swelling.
Prostate Enlargement (in men), which may be Benign or Malignant.
Stones (can be in the kidneys, ureter, or bladder).
Tumors (can be anywhere; inside, or outside the urinary tract and compressing it).
Enlarged Uterus in pregnant women.
Congenital Abnormalities (abnormal tissue that blocks the connection between the kidney and the ureter, or within the urethra), especially seen in pediatric age.
This is established through thorough medical history taking, physical examination as well as a comprehensive radiologic study.
This study includes plain kidney x-ray, kidney ultrasound, CT scan, intravenous pyelogram (IVP) and magnetic resonance imaging (MRI). Some of these studies may necessitate the administration of intravenous contrast (dye).
Other specialized diagnostic procedures that might be indicated, especially for the diagnosis of prostate enlargement or strictures of the urethra, include:
The treatment for Urinary Obstruction depends on its cause.
The goal is to get the urine flowing normally again. This will relieve pain and prevent damage to the kidneys and urinary tract. A thorough assessment will reveal the cause of the obstruction and accordingly, your trusted Urologist will decide on the best course of action.
For example, if the obstruction is between the kidney and the bladder (e.g. a kidney stone), then a drainage tube called “stent” can be inserted in the ureter through a Ureteroscope to drain urine from the kidney until the obstruction is relieved with further treatment.
If the obstruction is between the bladder and the urethra, a catheter is usually put into the urethra to drain urine from the bladder. A catheter is a thin, hollow, flexible tube.
The catheter is usually left in place for a couple of days to prevent the problem from happening again. It also allows the bladder to return to normal after having been stretched out from holding more than the normal amount of urine because of the blockage. This is to be followed by a more radical treatment for the cause.
Sometimes open surgery is necessary to relieve an obstruction in the urinary tract. This is occasionally true for very large stones, and often for an enlarged prostate.