Male Infertility

Infertility issues are painful, both emotionally and psychologically. Once a couple has decided to have children, the complete failure at pregnancy is a blow to the self-esteem of both of them. Women feel the pain of being childless while men feel a blow to their virility. Infertility issues may potentially be a problem on either side of the couple, male or female.

Although female infertility issues are more complicated, male infertility can raise issues that may or may not be reversible. When a couple first believes they may have infertility problems they should have had unprotected sex for at least 6 months without a conception. Most physicians ask the couple to attend the first infertility appointment together. There are some basic testing that can be done to quickly rule out the problem from the male side so that further testing can be performed on the woman.

Male infertility tests start with a physical examination and sperm analysis. A sperm analysis will tell the doctor if the sperm count is adequate, the motility (or movements) of the sperm are active and if the shape of the sperm is healthy. The production of sperm can be affected at different stages and from several physical findings.

Sometimes a doctor will find a varicocele on examination. This is a dilation of the vessels in the scrotum. It is caused by the reflux of blood from the spermatic vein. A varicocele is found in about 15% of the male population but the percentage increases to 40% in men who are presenting with problems of infertility.

A varicocele is suspected in male infertility tests when a man has a decreased sperm count. It is a common cause of secondary infertility. There are no specific risk factors for development of a varicocele and the reason they occur remains unclear. Doctors will be able to find them on examination but will usually confirm their presence with an ultrasound. This will also eliminate the possibility that the issue isn’t another type of pathology.

Treatment of varicoceles are done surgically or using a percutaneous embolization. There is a short recovery time and the major side effects are infection following the surgery, a recurrence of the varicocele and failure of the semen analysis to improve following the surgery.

A secondary goal of infertility evaluation is to identify any underlying health conditions. Although not specifically a male infertility test these conditions can contribute to problems with ejaculation, or erection. Undiagnosed diabetes, smoking, hypercholesterolemia or hypgonadism can all contribute to the release of sperm. It is not uncommon for men to report erectile dysfunction that is stress related during infertility evaluation and treatment.

Some patients taking psychotherapeutic agents that block dopamine production may complain of ejaculation and climax difficulty. These drugs will sometimes decrease libido or decrease vasodilation which decreases the quality of erections. Specific drugs such as tricyclic antidepressants, selective-serotonin reuptake inhibitors and MOA inhibitors can lead to erectile dysfunction and decreased libido.

Hypogonadism is a condition found on physical examination during male infertility tests. This is the failure of the testicles to produce normal levels of testosterone. The primary cause is testicular failure and secondary causes may be due to pituitary or hypothalamic causes. This is more common in aging males who have passed through their reproductive years. It is the only cause that can be treated successfully with hormone therapy.

Obesity can lead to aromatization of testosterone, when the testosterone seeps in the fatty tissue, which leaves less available for the normal functions of the hormone. This leads to decline in sperm. As a result some obese males can show a regression of secondary male sex characteristics. Evaluation of the testosterone levels will help to determine the degree of imbalance in the male system which is contributing to alterations in semen analysis. The most definitive treatment is weight loss.

All forms of hypogonadism can be confirmed with testosterone level monitoring, part of male infertility tests. Most men who are diagnosed with lower hormone levels may benefit from hormone therapy to stimulate their own system. The most difficult cases are those men who suffer from a form of hypgonadism from hypothalamic disorders.

Men who had previous vasectomies suffer from obstructive azoopermia. They are otherwise healthy men with normal semen amounts but no or poor quality sperm. They can be offered a reversal of the vasectomy to treat the infertility and may be candidates. The surgical approach will be based on the surgeon’s experience and the physical findings in the man. The reversal procedure becomes less successful as the time after the vasectomy increases.

A minority of men may have suffered an inadvertent vasectomy during a surgical procedure for another condition – such as a hernia repair as a child. In some cases they can be reconstructed.

Ejaculation obstruction is a condition where one or both of the ducts leading from the seminal vesicles into the prostate is partially or completely blocked. As a result only prostatic fluid is in the ejaculation. Without a surgical history this condition is suspected during male infertility tests following the semen analysis. Most semen will show a decreased volume, increased acidity and possible decreased sperm count and mobility.

Resources:

MayoClinic: Male Infertility

http://www.mayoclinic.com/health/male-infertility/DS01038

Stanford University: What Causes Male Infertility

http://www.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/causemal.htm

Center for Human Reproduction: Male Infertility

http://www.centerforhumanreprod.com/male_infertility.html

Urology Care Foundation: Male Infertility

http://www.urologyhealth.org/urology/index.cfm?article=102

Georgia Reproductive Specialists:Male Infertility

http://www.ivf.com/shaban.html

University of Maryland Medical Center: Infertility in Men