Fertisalus

Male Infertility

 

Overview

Infertility is a reproductive system disorder. It prevents a person from having children. It may affect both men and women. Infertility in men indicates an issue with the reproductive system. It signifies that you cannot conceive with your female spouse.

One in seven couples is infertile, which indicates that they have not been able to produce a child despite having regular, unprotected sexual relations for more than a year. Men’s infertility is at least partially to blame in up to half of these relationships.

Low sperm production, poor sperm function, or obstructions that limit sperm delivery are all possible causes of male infertility. Infertility in men may be caused by a variety of things, including physical ailments, mental health issues, poor dietary habits, and other personal decisions.

Male infertility may be a difficult and distressing experience, but there are a variety of treatment options available.

Symptoms & Characteristics

The inability to conceive a child is the most telling indicator of male infertility. Other than that, there may be nothing to look for.

An underlying issue such as an inborn abnormality, hormone imbalance, testicular vein dilation, or a condition that prevents sperm from passing through might create signs and symptoms in certain circumstances. You may notice the following signs and symptoms:

For example, trouble ejaculating, low sexual desire, or inability to sustain an erection are all examples of sexual dysfunction (erectile dysfunction).

  • Testicular discomfort, swelling, or a lump
  • A history of recurring respiratory illnesses
  • Lack of olfaction
  • Breast abnormality (gynecomastia)
  • A genetic or hormonal disorder, such as a loss of hair on the face or body, may be the cause of these symptoms.
  • A sperm count that is much lower than usual (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate).

Causes

What’s the cause of infertility in men?

Making mature, healthy, and mobile sperm relies on a variety of factors. Problems may impede the development of cells into sperm. Obstacles may prevent sperm from reaching the egg. Even scrotum temperature may influence fertility. These are the primary reasons for infertility in men:

  • Hormones Medication
  • Sperm Disorders
  • Immunologic Obstacles to Fertility
  • Varicoceles Retrograde Ejaculation

Several factors influence male reproduction in a natural state.

You should be capable of:

  • Create healthy sperm capable of fertilizing the egg.
  • Have an erection and ejaculate in order for the sperm to reach the egg.
  • Infertility may result from difficulties with any of these. Listed below are some of the most prevalent reasons for male infertility.

Sperm disorders

The most prevalent reason of male infertility is an inability to produce healthy sperm. Sperm may be immature, have an irregular form, or be incapable of swimming. In rare instances, you may not have sufficient sperm. Or you may not create any sperm. This issue may be caused by a variety of factors, including:

  • Infections and inflammatory disorders. After puberty, infection with the measles virus is one example.
  • Hormone or hypothalamic dysfunctions
  • Immune disorders in which antibodies are produced against one’s own sperm
  • Environmental and lifestyle considerations. These include nicotine usage, high alcohol use, marijuana or steroid use, and toxic exposure.
  • Genetic disorders include cystic fibrosis and hemochromatosis

Prevalent issues involve the production and growth of sperm. Sperm could:

  • not develop normally, have an abnormal form, or move improperly
  • produced in extremely small quantities (oligospermia)
  • not made in any way (azoospermia)
  • Sperm issues may be caused by innate characteristics. Lifestyle decisions may reduce sperm count. Tobacco use, alcohol use, and some medicines may reduce sperm count. Other reasons for low sperm count include chronic illness (like a renal failure), childhood illnesses (like measles), and chromosomal or hormone abnormalities (such as low testosterone).

Damage to the reproductive system may reduce or eliminate sperm production. About four out of ten men with azoospermia have obstructions in the tubes through which sperm move. A blockage might be caused by a congenital abnormality or an issue such as an infection.

Varicoceles

Varicoceles are scrotal vein enlargements. They are present in 16 out of every 100 males. They are more prevalent among sterile males (40 out of 100). They hinder sperm development by obstructing blood flow. It is possible that varicoceles cause blood to flow back from the abdomen into the scrotum. The testicles become too heated to produce sperm. This may result in decreased sperm counts.

Retrograde Ejaculation

Retrograde ejaculation is the retrograde movement of sperm inside the body. They enter the bladder instead of exiting the penis. This occurs when the nerves and muscles of the bladder do not contract during orgasm (climax). Semen may include normal sperm, but it is not discharged from the penis and hence cannot reach the vagina.

Retrograde ejaculation may be induced by surgery, drugs, or neurological system disorders. Signs include murky urine after ejaculation and “dry” or less fluid ejaculation.

Immunologic Fertility Failure

Occasionally, a man’s body produces antibodies that target his own sperm. Antibodies are often produced in response to trauma, surgery, or illness. They hinder the proper movement and function of sperm. We do not yet know precisely how antibodies reduce fertility. We do know that they may make it difficult for sperm to access an egg through the fallopian tube. This is not a prevalent reason for male infertility.

Obstruction

Sometimes the tubes that sperm pass through might get clogged. Blockage may be caused by repeated infections, surgery (such as vasectomy), edema, or developmental problems. Any component of the male reproductive system is susceptible to obstruction. Sperm from the testicles cannot escape the body after ejaculation if there is a blockage.

Hormones The pituitary gland’s hormones instruct the testicles to produce sperm. Very low hormone levels inhibit sperm development.

Chromosomes

Sperm provides 50 percent of the DNA to the egg. Fertility is affected by changes in the number and shape of chromosomes. For instance, the male Y chromosome may be incomplete.

Medication

Certain drugs may affect the generation, function, and transport of sperm. These drugs are often used for the treatment of:

  • Arthritis 
  • Depression
  • Digestive troubles
  • Anxiety or depressive illnesses
  • Cancer and high blood pressure

Les do not produce sperm owing to inadequate activation by pituitary hormones. This is related to pituitary or hypothalamic dysfunction. It is the cause of a minor proportion of male infertility. It may present from birth and often manifests when a young guy is expected to reach puberty (“congenital”). Or it may appear later (“acquired”).

The congenital type, commonly known as Kallmann’s syndrome, is characterized by low gonadotropin-releasing hormone levels (GnRH). Hypothalamus produces GnRH as a hormone. The acquired form may be induced by a variety of health conditions, including:

malignancies of the pituitary gland, head trauma, and steroid usage.

If hypogonadotropic hypogonadism is suspected, your physician may recommend that you have an MRI. This will display an image of the pituitary gland. In addition, you will have a blood test to measure prolactin levels. A combination of an MRI and blood test may detect pituitary tumors. If there are elevated prolactin levels but no tumor on the pituitary gland, your healthcare professional may initially attempt to reduce your prolactin levels. Next would be replacement treatment with gonadotropins. During therapy, testosterone levels in the blood and sperm will be measured. Probability of pregnancy is quite high. Normal sperm are produced by this procedure.

Genetic Disorders

Some males are born with a genetic disorder that may be new (not present in other family members) or inherited (passed down from mother and/or father), manifesting in the afflicted individual first. The known causes of genetic abnormalities are most frequently detected in men with no sperm in the ejaculate (azoospermia), where the condition affects sperm production (e.g., Klinefelter syndrome, where an extra chromosome is present in the man, or Y chromosome microdeletions, where a small portion of genetic tissue is missing). In addition, genetic disorders may impair the development of the male tract that transports sperm, preventing the creation of the sperm-carrying tubes.

Retrograde Ejaculation

Retrograde ejaculation, in which sperm flows back into the penis rather than out, has several reasons. It may be brought on by:

  • Prostate or bladder operations
  • Diabetic spinal cord damage
  • Certain antidepressants and antihypertensives are used to treat prostate enlargement (BPH)

Retrograde ejaculation is detected by detecting sperm in the urine. This is conducted immediately after ejaculation under a microscope. It is possible to treat retrograde ejaculation with medication.

It is often first treated with over-the-counter drugs such as Sudafed®. If drugs fail and you need assisted reproductive methods (ARTs), your healthcare professional may collect sperm from your bladder after ejaculation if you require ARTs.

Operative Treatment for Male Infertility

Varicocele Treatments

Varicoceles are treatable with a modest outpatient procedure known as varicocelectomy. The treatment of these enlarged veins improves sperm motility, quantity, and structure. Please go to our Varicocele Treatments page for further information.

Azoospermia Treatments

If spermlessness (azoospermia) is caused by a blockage, there are several surgical options.

Even males with poor sperm production as the reason of no sperm in the ejaculate may be addressed with surgery to discover sperm and aided reproduction, since millions of sperm must be produced in the testicles before any survive to reach the semen.

Microsurgical Vasovasostomy

Vasovasostomy is performed to reverse a vasectomy. Each testicle’s vas deferens is reattached by microsurgery to its two severed ends. Please visit our Vasectomy Reversal page for further information about this procedure.

Vasoepididymostomy

Vasoepididymostomy connects the vas deferens’ upper end to the epididymis. It is the most prevalent microsurgical treatment for epididymal blockage. Please visit our Vasectomy Reversal Page for further information about this therapy.

Transurethral Ejaculatory Duct Resection (TURED)

Ejaculatory duct obstruction may be surgically addressed. A tiny incision is made in the ejaculatory duct and a cystoscope is inserted into the urethra (the tube within the penis). Approximately 65 out of 100 males have sperm enter the sperm. However, there may be issues. Blockages might return. Incontinence and retrograde ejaculation are uncommon but potential complications of bladder injury. Additionally, only one in four couples get pregnant spontaneously after therapy.

Treatment for Unknown Male Fertility Causes

It might be difficult to determine the reason of male infertility at times. This condition is known as idiopathic male infertility. Your healthcare professional may use expertise to determine what is effective. This is known as empirical treatment. As hormones are a common cause of infertility, empiric treatment may be used to regulate hormone levels. It is difficult to predict how effective empirical therapy will be. Each situation is unique.

Assisted Reproductive Techniques

If infertility therapy fails or is unavailable, it is possible to get pregnant without sexual contact. These procedures are known as assisted reproductive technologies (ARTs). Based on the precise kind and reason of infertility, your healthcare physician may recommend:

Intrauterine Insemination (IUI). Through a catheter, sperm is inserted into the uterus of the female partner during IUI. IUI is often effective for low sperm count and movement issues, retrograde ejaculation, and other infertility factors.

In Vitro Fertilization (IVF). IVF involves combining the egg of a female partner or donor with sperm in a laboratory Petri dish. IVF requires stimulation of the ovaries to create numerous eggs (ova). This is often accomplished with regular injections of medicines. It enables for the retrieval of several mature eggs. After three to five days, the fertilized egg (embryo) is returned to the uterus. IVF may be used to address a variety of hormone disorders in women, including blocked tubes and idiopathic infertility (where there is no cause that explains the fertility problem). However, it is increasingly utilized when a man has really severe and untreatable oligospermia (low sperm count).

Intracytoplasmic Injection of Sperm (ICSI). ICSI is an alternative to IVF. It has changed severe male infertility therapy. It allows infertile couples to get pregnant. With a small needle, a single sperm is inserted into an egg. Once the egg has been fertilized, it is placed in the uterus of the female partner. If the quality of your sperm is exceedingly low, your doctor may recommend ICSI. It is also utilized if there are no sperm in the sperm due to an irreparable obstruction or testicular failure. Sperm may also be extracted surgically from the testicles or epididymis.

Sperm Retrieval for ART. Numerous microsurgical techniques may remove obstructed sperm due to obstructive azoospermia (no sperm). The objective is to get the highest quality and quantity of cells. This is done without causing damage to the reproductive system. These strategies include:

Testicular Sperm Extraction (TESE). This is a typical method for diagnosing the cause of azoospermia. It also provides sufficient tissue for sperm extraction. Sperm extracted from the testis may be utilized either fresh or frozen (“cryopreserved”). One or more tiny biopsies are often performed in an office setting. A highly refined version of this treatment is microTESE, in which an operational microscope is used to find tiny pockets of sperm production in the testicles of men whose sperm production is so poor that no sperm survive to become semen.

Fine Needle Testicular Aspiration (TFNA). TFNA was first used to identify azoospermia. Currently, it is sometimes used to extract sperm from the testicles. The scrotal skin is pierced with a needle and syringe in order to extract sperm from the testicle.

Percutaneous Sperm Extraction from the Epididymis (PESA).. PESA may be performed under either local or general anesthesia. The urologist pierces the epididymis with a needle linked to a syringe. Then, he or she withdraws fluid carefully. Sperm may not always be obtained in this manner. You may still need an open operation.

Microsurgical Sperm Extraction from the Epididymis (MESA). Sperm are also extracted from the epididymal tubes using MESA. This procedure employs a surgical microscope. MESA produces large quantities of motile sperm. They can be stored and thawed for IVF procedures in the future. This technique minimizes damage to the epididymis.

Result of Treatment Male infertility is often treatable with an outpatient treatment. These are performed with general anesthesia or intravenous sedation. While postoperative discomfort is often minor, recovery and follow-up differ. After a varicocele repair, your doctor should do a physical examination. This is to determine if the vein has entirely disappeared. Frequently, the veins remain swollen after surgery, since they are not eliminated but rather blocked up to avoid aberrant blood flow. About every three months for at least a year, or until pregnancy, sperm should be checked. If your varicocele reappears or you remain infertile, see your doctor about ARTs.

After surgery, vasectomy reversals produce relatively minimal discomfort. Expect a recovery period of four to seven days. The likelihood of pregnancy relies on several factors. It mostly relies on your female partner’s age and fertility. The amount of years that have passed between your vasectomy and reversal also impacts its success. The longer you wait, the lower the probability that the reversal will be successful.

Frequent Requested Information

What health conditions might result in male infertility?

Numerous health conditions, including renal illness and testicular cancer, may cause male infertility. Normal fevers and infections, as well as “whole-body” illnesses and metabolic abnormalities, may inhibit sperm development. Sexually transmitted diseases may cause obstructions and scarring in the reproductive system.

In the absence of the vas deferens or seminal vesicles, there will be no sperm in the semen if a man has a genetic disorder, such as cystic fibrosis. Numerous diseases may result in infertility. It is essential that you and your spouse inform your health care professional with family and personal health histories.

Can tobacco smoke impact sperm?

Yes. Numerous studies have shown that smoking damages sperm in various ways. It causes sperm cells to shrink and move more slowly. It causes DNA damage. Smoking may also influence the seminal fluid containing sperm that is ejaculated.

Can steroid usage for bodybuilding result in infertility?

Yes. Oral or injected steroids might cause the body to cease producing the hormones required to produce sperm.

Does faulty sperm analysis or sperm contribute to birth defects?

Perhaps not necessarily. The chance of conceiving a child with a birth defect is comparable for the majority of couples seeking reproductive therapy and the general population. Some (mostly genetic) causes of infertility may also increase the likelihood of having a kid with birth abnormalities. Therefore, before to engaging in various kinds of ARTs, couples must undergo extensive examinations and get counsel.

What is the most important fact I need to know regarding male infertility?

Infertility is not the fault of either you or your spouse. The American Society for Reproductive Medicine (ASRM) believes that in around one-third of instances of infertility, the male is to blame. Another third are women.

In the last one-third of infertile couples, the issue is either caused by a mix of factors or cannot be explained in 20% of instances.

In males, sperm deficiency or absence is the greatest issue. In women, ovulation disorders and obstructed tubes are the most prevalent issues. Today, however, technology and surgical instruments exist to solve a number of these issues.

What are assisted reproductive technology (ART) techniques?

ARTs are high-tech ways for combining sperm and egg when sexual reproduction fails. If pregnancy does not occur despite the presence of sperm in your sperm, your doctor may advise one or more assisted reproductive technologies (ARTs).

When should my spouse and I explore sperm retrieval using an assisted reproductive technology (ART) rather than surgery if I have blockage resulting in no sperm in the ejaculate (obstructive azoospermia)?

ART is often unnecessary when microsurgical correction is performed. Even after surgery to correct the blockage, sperm may be extracted from the testicle or epididymis and injected into your partner’s eggs using ICSI if that fails. ICSI is used because the amount of motile sperm is often low and they travel poorly.

There are several ways to retrieve sperm cells. The decision will be made jointly by you and your urologist. Sperm retrieval may be performed before to or simultaneously with egg retrieval and IVF.

Numerous reproductive institutions favor using “fresh” sperm collected on the same day as egg retrieval. Others prefer earlier-harvested, frozen sperm. Sperm may be extracted by microsurgery or aspiration.

When should my spouse and I pursue an assisted reproductive technology (ART) rather than surgery if I have a varicocele?

If both you and your spouse have reproductive issues and she cannot conceive naturally, one of the ARTs may be more effective than surgery. However, the option is not always obvious. You and your physician should consider the following:

the age and ovarian function of the female spouse, and if ART may be required even if varicocele surgery is performed.

There is a possibility that a varicocele surgery may not completely restore your fertility.

If the varicocele is not healed, assisted reproductive technology is required for each pregnancy attempt.

research indicating that varicocele treatment may improve IUI and IVF success

If you do not have excellent sperm but your spouse is fertile, varicocele repair should be favored. IVF, with or without ICSI, should be the treatment of choice when there is a specific necessity to treat a woman’s infertility using such procedures.

Exist hazards associated with IVF/ICSI?

Yes, there are hazards, mostly for women. Mild ovarian hyperstimulation occurs in 10 to 20 of every 100 IVF patients. It is due to the hormones used in IVF/ICSI procedures. The majority of women with mild instances may effectively manage their symptoms. There is mild hyperstimulation in 5 percent of IVF patients.

However, extreme hyperstimulation may result in high blood pressure, fluid retention, depression, and other symptoms. These symptoms need hospitalization for treatment. Only 1 in 100 women undergoing IVF experience severe hyperstimulation. This condition may create severe health issues.

With IVF/ICSI, multiple births are also conceivable. In the United States, the likelihood of having twins after IVF is between 10 and 20 percent, whereas the risk of having triplets or more is less than 1 percent.

Are the pituitary tumors that generate low gonadotropin or elevated prolactin levels cancerous?

No. These are often benign (non-cancerous) pituitary gland tumors. Surgery is becoming an uncommon occurrence in comparison to the widespread use of medications. If the tumor is sufficiently big, you should see a neurosurgeon regarding its removal. Frequently, the tumor is extracted by the nose.

Should I pursue hormonal treatment as an experiment if I also have a varicocele?

In the majority of situations, untested empiric remedies should not be attempted until recognized, treatable causes have been addressed. In the United States, varicocele is the primary cause of decreased sperm production. Repair should be explored prior to any hormonal intervention. In major scientific investigations, the advantages of empiric hormonal treatment, such as recombinant FSH or clomiphene citrate, seem to be modest.

Given the detrimental effects of oxidants on sperm function, should all infertile men use vitamin E?

While vitamin E is typically well tolerated, there is little evidence to advocate its use (or that of other antioxidants) to increase pregnancy rates.