Male infertility: determinants and treatment

Male infertility: determinants and treatment

Male infertility: determinants and treatment

In about 50% of couples who have difficulty conceiving a child, the man is the one affected by infertility. As in the case of women, the causes that determine it relate to a wide spectrum of predominantly pathological, but also psychological, factors.

Seen through the male prism, infertility becomes a more delicate and more difficult problem to accept, mostly because of prejudice and the immediate but wrong association with impotence. However, it is important to know that many infertile men can have perfectly normal, satisfying sex.

The standard investigation for the evaluation of the male partner is the spermogram, which ensures an analysis of the semen, the concentration and motility of the sperm, as well as their morphological aspects. Depending on the results, additional tests may be recommended, such as sperm culture, sperm biochemistry, urethral secretion culture, urine analysis to investigate retrograde ejaculation or genetic testing.

What are the causes of male infertility?

From the point of view of the causes, the problem of male infertility remains as complex as the female one: the determining factors are varied and multiple, starting from hormonal imbalances to physical or psychological problems. Also, lifestyle can play an important role in causing infertility, which is why men who adopt a balanced and healthy lifestyle are likely to produce more viable sperm.

An important cause of male infertility, but not the only one, is varicocele, represented by dilated vessels on the scrotum, which can lead to a reduction in sperm count and quality.

Other causes may be:

Sexually transmitted infections such as those produced by Chlamydia, Mycoplasma, gonorrhea, inflammation of the prostate or testes.

History of mumps with testicular impairment (orchid orchid)

Blockages in the ducts that carry sperm - some men have blockages in the epididymis or different channels. People with cystic fibrosis or other hereditary problems can be born even without deferential channels (CAVD).

Hormonal imbalances - Testicular disorders may be associated with impairment of other hormonal systems such as the hypothalamus, pituitary gland, thyroid and adrenal glands. Low testosterone along with other hormonal problems underlie male infertility.

Certain medicines - testosterone therapy, long-term steroid use, certain antifungal drugs.

Chromosomal defects - they can be inherited, such as Klinefelter syndrome, in which, a man is born with one Y chromosome and two X chromosomes (instead of one X chromosome and one Y chromosome).

Testicular tumors - which can be detected when infertility is investigated

Also, environmental factors such as Industrial chemicals, exposure to heavy metals, radiation, as well as drug use, smoking, alcohol, stress, body mass influence male fertility.

"Most of the time, male infertility does not show any obvious signs or symptoms, except for the inability to conceive a child. However, there are some situations in which the existence of this condition is felt, presenting symptoms such as sexual dysfunction, pain or swelling in the testicular area. , reduced facial and body hair and a semen production below the normal level "- he says Dr. Daniel Damian, primary urology physician specializing in andrology, infertility, reproductive surgery and endourology at Gynera Fertility Center.

If the man has one or more of these symptoms, a medical consultation, usually performed by a urologist, is recommended. After a physical examination, he recommends making a spermogram to check the quantity and quality of the sperm. Sperm abnormalities are classified according to the affected parameters. These are oligozoospermia, asthenozoospermia, teratozoospermia and azoospermia.

oligozoospermia consists in reducing the number of sperm in the spermogram, classified, in turn, in moderate or severe oligozoospermia. This condition is manifested by the inability to conceive a child, and if the causes are hormonal, the main symptoms are disorders of the sexual act, changes in the testicular area or changes in the male secondary characters.

asthenozoospermia consists of the difficulty of the sperm to move. If they are too slow, the chances of them fertilizing an egg are very small.

Teratozoospermia consists of the presence of sperm with morphology or altered structure. Poor form of sperm prevents the fertilization of the eggs. These abnormalities of sperm are caused by the hormonal and metabolic imbalances that influence the sperm formation process. They have no symptoms and can only be detected by the doctor.

azoospermia consists of the absence of sperm from the semen upon ejaculation. This condition can be of two types: obstructive and non-obstructive. The obstructive one appears in 40% of the cases and is caused by an obstruction of the elimination channel, and the non-obstructive one appears in 60% of the cases and is the result of deficiencies of sperm production.

More than half of the cases of iMale infertility is due to the reduced number of sperm eliminated and their poor quality. The sperm of the man must be healthy and contain sufficient mobile sperm of normal structure, for the fertilization of an egg. Any alteration of these attributes can cause infertility.

How can male infertility be treated?

More than 50% of cases diagnosed with male infertility can be corrected by:

Surgery - for repair of dilated vessels at scrotum level (varicocele)

Drugs - they can improve retrograde ejaculation. Clomiphene or gonadotropin are recommended for pituitary hormone deficiency.

Assisted reproduction - depending on the condition that causes infertility, fertilization is done through complex laboratory methods. These are mainly:

- ICSI (Intracytoplasmic sperm injection)

The choice of the procedure is determined by the established cause of infertility and may involve, in extreme cases, including sperm harvesting through a surgical procedure from the channels that transport sperm or even directly from the testicles).

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