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Causes of Male Infertility and Treatment Options
Male infertility is related
to testicular disease, hormone deficiencies and structural problems with the
male reproductive organs, as well as exposure to certain chemicals,
chemotherapy agents or radiation treatment for cancer. Substances such as
alcohol, marijuana and other illegal drugs, anabolic steroids and some herbal
remedies especially those that affect hormone levels - have been linked to
low sperm count and/or abnormal sperm movement or shape. Certain prescription
medications, including those for ulcers, hypertension, epilepsy and depression
also can contribute to infertility. Nicotine has been shown to have some
negative effect on testosterone production, which adversely affects sperm
production and development. Also, certain illnesses that include high fever
can temporarily affect sperm count and motility. The common causes of
male-factor infertility are:
Read the descriptions
below to learn more about the causes of infertility.
Infections
Infections in the male
reproductive organs can be caused by sexually transmitted diseases, mumps
contracted as an adult and bacteria. Unless noticeable symptoms occur, these
infections can go untreated. Severe infection can cause scarring, blockages
and/or other damage to the male reproductive organs.
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Treatment Options for Infection
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Medications
antibiotics can be effective in treating infections of the male
reproductive disorders; however, it is important to treat them early to
avoid permanent damage.
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Surgery
may be required in cases where infection has resulted in scarring or
blockages that affect sperm production and/or ejaculation.
Hormonal Imbalances
Problems with the
hypothalamus and pituitary glands glands in the brain that produce
reproductive hormones - can affect sperm production and sexual function.
Thyroid problems also can lead to low levels of testosterone, follicle
stimulating hormone (FSH) and luteinizing
hormone (LH) required for sperm production.
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Treatment Options for Hormone
Imbalances
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Medication
may be prescribed for certain hormonal imbalances. Human chorionic
gonadotropin (hCG) supports the production of testosterone in the male
reproductive organs. Clomiphene citrate helps the hypothalamus and pituitary
glands produce the chemical that stimulates LH and FSH production. These in
turn regulate testosterone production and improve sperm production.
Sexual Dysfunction
Male sexual dysfunction can
be related to medical conditions and psychological issues including stress. In
some cases, age plays a part. Although age-related changes in male fertility
are not as pronounced as those in the female, sex drive, sexual function and
the ability to conceive can be diminished by changes in the testes, the
quality of sperm and hormone-related problems. Still, men continue to produce
sperm and can conceive at ages well beyond those at which women experience
menopause and the end of fertility.
Many males produce plentiful, high quality sperm but they experience problems
ejaculating. With premature and delayed ejaculation, timing prevents orgasm
and the release of sperm into the vagina during intercourse. Retrograde
ejaculation is when semen is released backwards, into the bladder, as a result
of trauma, nerve damage or other problems from prostate or lower back surgery,
birth defects and diseases including diabetes and multiple sclerosis.
Retrograde ejaculation also is linked to certain prescription drugs, including
those for depression and high blood pressure.
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Treatment Options for Sexual
Dysfunction
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Medication
may be available to address sexual dysfunction depending on the
nature of the problem and the cause. Fertility medications can be
prescribed to restore hormonal balance, increase the sex drive, restore
sexual function or improve performance. Oral medications may be
effective in improving retrograde ejaculation by helping the bladder
neck close during ejaculation.
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Surgery
recommended in cases where sexual dysfunction results from scarring,
blockages or growths that can be removed surgically.
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Insemination
in cases involving retrograde ejaculation, sperm may be found in the
urine. If healthy sperm can be extracted, insemination is an option. In
cases where timing is the problem, collection of sperm through
masturbation and insemination may be recommended.
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Therapy
"performance anxiety" that contributes to several forms of
sexual dysfunction can be addressed with therapy directed at the cause
and/or focused on techniques to reduce stress and restore sexual
confidence and function.
Sperm Quantity and Quality
Although only one sperm is
needed for conception, millions are released during intercourse to increase
the chance of pregnancy. A fertile male ejaculates at least 2 milliliters of
semen with the right consistency to transport at least 40 million sperm toward
the waiting egg(s). Of these, at least 50% should be moving vigorously through
the liquid, 2% must be moving forward and at least 4% should have a normal
shape - an elliptical head and tail to provide the thrust they need.
Poor sperm count and quality are indicators of male-related infertility. If a
semen sample also includes too many white blood cells, bacteria, sexually
transmitted diseases or infection also may be contributing to the problem.
Males exposed to DES (diethylstilbestrol) a synthetic hormome taken by
pregnant women in the 1960s and 1970s, also may have anatomical abnormalities
and problems with sperm count, movement and shape.
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Treatment Options for Poor Sperm
Count or Quality
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Medication
antibiotics may be prescribed to treat infection affecting sperm
quality.
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Surgery
microsurgical
epididymal sperm aspiration (MESA and TESA) are
surgical techniques recommended when there are few or no sperm in the
ejaculate as a result of vasectomy,
congenital absence of the vas deferns or epididymis,
prior failed surgery or epididymal scarring from infection. Tissue is
collected from the testes and processed in the laboratory to remove
healthy sperm for use with intracytoplasmic
sperm injection (ICSI). Used with in vitro fertilization (IVF), ICSI
involves injection of a single sperm into the core of an egg.
Blockages and Other Anatomical Problems
Structural defects in
reproductive organs can stop the passage of sperm from the testis, where they
develop, to the ejaculatory duct. Blockages result from birth defects or scar
tissue formed after infection or surgery. Vasectomy, an elective sterilization
procedure, prevents the flow of sperm by cutting and tying off the ends of the
vas
deferens, a tube that carries sperm from the epididymis to the ejaculatory
duct.
Some experts believe that blocked and enlarged veins around the testes, called
varicoceles, cause infertility by raising the temperature in the
scrotum and decreasing sperm production. However, others discount the effect
of varicoceles because they also are found in fertile men.
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Treatment Options for Blockages and
Other Anatomical Problems
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Surgery
vasectomy reversal (vasovasostomy)
is a microsurgical technique that involves removal of scarred sections
and reconnection of the vas deferns so sperm can travel out of the
epididymis and into the ejaculate. Epididymal repair (vasoepididymostomy)
may be an option if vasovasostomy wont work because there are no
sperm present in the vas deferns. This surgery is used to remove
obstructions in the epididymis caused by pressure from testicular
fluids, leakage of sperm into surrounding tissues after a vasectomy,
infections, trauma or congenital defects. Vasoepididymostomy restores
the flow of semen by stitching the inner and outer layers of the vas
directly to the epididymis and its inner tubule, at a point above an
obstruction.
Varicocele
A varicocele is an abnormally
swollen (varicose) vein that diminishes or blocks blood flow around the
testes. Because they raise the temperature of the scrotum, varicoceles have
been linked to poor sperm production and quality. However, varicoceles also
are present in fertile men, causing debate over the effectiveness of
treatment.
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Treatment Options for Varicoceles
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Immune System Disorders
The production of sperm
doesnt occur until a male reaches puberty. Normal function can be
interrupted by surgical sterilization (vasectomy), trauma or infection. In
some cases where sperm are first or once again produced, the males immune
system identifies them as foreign substances and creates antisperm
antibodies. The antibodies are designed to destroy the invading cells
by attaching themselves to the sperm, preventing their passage or
fertilization.
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Treatment Options for Immune System
Disorders
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Medication
steroids may be prescribed to destroy the antibodies.
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Sperm washing
collected through masturbation, sperm is washed in the laboratory to
remove antibodies. The options are to inject them directly into the
female during Intrauterine
Insemination (IUI) or into a laboratory dish containing eggs
retrieved from the female during in vitro fertilization (IVF).
Hypospadias
As a result of this
congenital condition, the opening of the urethra is not located at the end of
the penis and semen cant be ejaculated into the vagina during intercourse.
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Treatment Options for Hypospadias
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Insemination
semen is collected through masturbation, washed of impurities and
injected directly into the uterus during intrauterine insemination.
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Surgery
permanent correction of the problem with surgery may be an option.
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