The presence of normal sperm is essential in achieving fertilization and subsequent pregnancy. Male patients can have low counts of sperm, a low percentage of sperm swimming, and/or a low percentage of normally shaped sperm. The causes of male infertility can be divided into four main categories. The first is disorders affecting parts of the brain called the hypothalamus and pituitary. In these men, certain hormones are not released normally in order to produce the normal amount of sperm. The second cause of male infertility is related to disease in the testicle. If there is any abnormality in the testes, this can lead to an abnormality with the sperm. The third cause is related to an obstruction in the transport of the sperm and the last is deemed unexplained.
We test the integrity of the male’s sperm by performing a semen analysis. This evaluates the volume of the sample produced, the number of sperm, the percent that are motile, and the percent that are normally shaped.
As mentioned, the male is responsible in up to 50% of cases of infertility. Ideally therefore, the initial screening evaluation of the male should be performed early in the infertility workup.
Careful medical histories sometimes will point for a possible explanation of the abnormal semen analysis. The following list of questions are commonly asked to the male partner in trying to elucidate a cause for the abnormality:
- Timing of puberty: Important because delayed puberty could be associated with certain diseases such as Klinefelter’s syndrome.
- Childhood illnesses: Such as undescended testicles or mumps.
- History of trauma: Testicular trauma can lead to vascular injuries that will permanently damage the testicles.
- History of torsion: Testicular torsion occurs when the testicle twists on its pedicle causing a hindrance to blood flow.
- Previous surgical procedures: Such as bladder operations or surgery for testicular cancer.
- History of heat exposure: A generalized febrile illness can interfere with sperm production because of the elevated temperature. One episode of such high fevers can affect the sperm for 3 months until a new batch is formed. Certain activities that are associated with increased testicular heat can affect sperm count and function, such as frequent use of jaccuzzis, saunas, or even hot tub usage. The elevated temperature from these activities might impair sperm production.
- History of exposure to toxins: These toxins, whether occupational, environmental can affect fertility. Radiation, agricultural chemicals, lead, cancer chemotherapy medications are but some of these detrimental agents.
- History of smoking: Both cigarette smoking and marijuana have been associated with infertility.
- History of venereal diseases, such as Gonorrhea or Chlamydia.
- History of alcohol use.
- Sexual habits including use of lubricants: Many such lubricants (K-Y Jelly, Keri lotion) and even saliva have been shown to affect sperm motility.
- Timing of intercourse.
- History of medication intake: A variety of medications can affect reproductive function. Some of these medications include Sulfasalazine (used for colitis treatment), spironolactone (diuretic), Cimetidine (for ulcers), erythromycin, Gentamycin (antibiotics).
More often than not however, it is very difficult to explain the cause of low sperm count or motility.
The male is responsible in up to 50% of cases of infertility. Ideally therefore, the initial screening evaluation of the male should be performed early in the infertility workup.
The diagnosis of male infertility might fall in the following categories:
- Unexplained: One of the most common diagnoses, usually due to a genetic factor.
- Varicocele: Swelling of the veins present around the testicular ducts (epididymis) can cause a slowing of the blood flow with resultant increase in temperature and therefore interference with sperm count and function. This is one of the most common diagnoses made in the infertile man.
- Obstructive: Could be due to an inborn genetic abnormality such as the absence of the vas deferens or it could be acquired from surgery or infection.
- Immunologic: Such as the presence of sperm antibodies that can attach to the sperm head and interfere with fertilization.
- Environmental: These include medications, radiation or chemical exposure.
- Hormonal: Abnormalities in the secretion of certain hormones by the pituitary gland or the testicles can lead to abnormal sperm production.
- Sexual dysfunction: Problems with erection and ejaculation can certainly play a role in male factor infertility.
Male Fertility: Dr. Sahakian
To determine the cause of male infertility, we can perform a semen analysis, checking the count, motility, and morphology, or shape, of sperm.