| Male infertility | |
|---|---|
| Classification and external resources | |
| ICD-10 | N46. |
| ICD-9 | 606 |
| DiseasesDB | 7772 |
| MedlinePlus | 001191 |
| eMedicine | med/3535 med/1167 |
| MeSH | D007248 |
Male infertility refers to infertility in male humans.
Male infertility is involved in a sexually paired couple's inability to conceive in a significant number of cases, with estimates ranging from 40-50%. [1][2][3]
Contents |
Causes
Factors relating only to male infertility include[4]:
Pretesticular causes
- Hypogonadism due to various causes
- Drugs, alcohol, smoking
- Strenuous riding (bicycle riding,[5] horseback riding)
Testicular factors
Testicular factors of male infertility include:
- Bad semen quality
- Oligospermia - low semen volume
- Oligozoospermia - few spermatozoa in semen
- Aspermia - complete lack of semen
- Azoospermia - absence of sperm cells in semen
- Teratospermia - sperm with abnormal morphology
- Asthenozoospermia - reduced sperm motility
There are various combinations of these as well, e.g. Teratoasthenozoospermia, which is reduced sperm morphology and motility.
Factors that, in turn, affect the semen quality include:
- Genetic defects on the Y chromosome
- Abnormal set of chromosomes
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Cryptorchidism
- Varicocele (14% in one study)[6][7]
- Trauma
- Hydrocele
- Mumps[8]
- Malaria
- Testicular dysgenesis syndrome
- Defects in USP26 in some cases[9]
Posttesticular causes
- Vas deferens obstruction
- Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
- Infection, e.g. prostatitis
- Retrograde ejaculation
- Hypospadias
- Impotence
- Acrosomal defect/egg penetration defect
Diagnosis
The diagnosis of infertility begins with a medical history and physical exam by a urologist, preferably one with experience or who specializes in male infertility. The provider may order blood tests to look for hormone imbalances or disease. A semen sample will be needed. Blood tests may indicate genetic causes.
Efficiency
In the majority of cases of male infertility and low sperm quality, no clear cause can be identified with current diagnostic methods.
Medical history
The cornerstone of the male partner evaluation is the history. It should note the duration of infertility, earlier pregnancies with present or past partners, and whether there was previous difficulty with conception.
The history should include prior testicular or penile insults (torsion, cryptorchidism, trauma), infections (mumps orchitis, epididymitis), environmental factors (excessive heat, radiation, chemotherapy), medications (anabolic steroids, cimetidine, and spironolactone may affect spermatogenesis; phenytoin may lower FSH; sulfasalazine and nitrofurantoin affect sperm motility), and drug use (alcohol, smoking).
Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner's previous fertility experiences are important.
Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy (retrograde ejaculation), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).
Physical examination
A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastia may suggest androgen deficiency.
Usually, the patient disrobes completely and puts on a gown. The physician will perform a thorough examination of the penis, scrotum, testicles, anus and rectum.
The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically and physically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.
The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.
Sperm sample
The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed. This is the most common type of fertility testing[10].
Blood sample
A blood sample can reveal genetic causes of infertility, e.g. a Y chromosome microdeletion, cystic fibrosis.
Prevention
Some strategies suggested or proposed for avoiding male infertility include the following:
Treatment
Medication or surgery are the primary means of treating male infertility.[13]
Generally, there is no effective medication for sperm quality causes like e.g. oligospermia. [14] Medications include Clomiphene citrate, an anti-estrogen drug designed as a fertility medicine for women but sometimes used to boost sperm production in men with low sperm counts and poor sperm motility.[citation needed] Vitamin E helps counter oxidative stress, which is associated with sperm DNA damage and reduced sperm motility.[citation needed] Azoospermia can sometimes be treated with HCG injections.[citation needed] If that fails after six months, FSH can be added. A hormone-antioxidant combination may improve sperm count and motility.[15]
Surgery is often the choice in posttesticular causes.
IVF or even ICSI may be additional alternatives.[14]
See also
Literature
- M. Crausaz, J. Vargas, R. Parapanov, Y. Chollet, M. Wissard, E. Stettler, A. Senn, M. Germond: First Evaluation of Human Sperm Quality in Various Geographic Regions in Switzerland. Chimia 62 (2008), 395–400. doi:10.2533/chimia.2008.395
References
Treatment of male infertility in Pakistan
- ^ "Men's Health - Male Factor Infertility". http://healthcare.utah.edu/healthinfo/adult/men/infertil.htm. Retrieved 2007-11-21.
- ^ Brugh VM, Lipshultz LI (2004). "Male factor infertility: evaluation and management". Med. Clin. North Am. 88 (2): 367–85. doi:. PMID 15049583.
- ^ Hirsh A (2003). "Male subfertility". BMJ 327 (7416): 669–72. doi:. PMID 14500443.
- ^ Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge University Press, 2000. ISBN 0-521-77474-8.
- ^ Leibovitch I, Mor Y (2005). "The vicious cycling: bicycling related urogenital disorders". Eur. Urol. 47 (3): 277–86; discussion 286–7. doi:. PMID 15716187.
- ^ "Infertility in men". http://www.umm.edu/patiented/articles/what_causes_of_male_infertility_000067_4.htm. Retrieved 2007-11-21.
- ^ Costabile RA, Spevak M (2001). "Characterization of patients presenting with male factor infertility in an equal access, no cost medical system". Urology 58 (6): 1021–4. doi:. PMID 11744480.
- ^ Masarani M, Wazait H, Dinneen M (2006). "Mumps orchitis". Journal of the Royal Society of Medicine 99 (11): 573–5. doi:. PMID 17082302.
- ^ Zhang J, Qiu SD, Li SB, et al. (2007). "Novel mutations in ubiquitin-specific protease 26 gene might cause spermatogenesis impairment and male infertility". Asian J. Androl. 9 (6): 809–14. doi:. PMID 17968467.
- ^ Fertility Testing
- ^ Gaur DS, Talekar M, Pathak VP (2007). "Effect of cigarette smoking on semen quality of infertile men". Singapore medical journal 48 (2): 119–23. PMID 17304390.
- ^ Goyal A, Delves GH, Chopra M, Lwaleed BA, Cooper AJ (2006). "Prostate cells exposed to lycopene in vitro liberate lycopene-enriched exosomes". BJU Int. 98 (4): 907–11. doi:. PMID 16978292.
- ^ myOptumHealth -> Treating male infertility By Lila Havens, Staff Writer
- ^ a b drmalpani.com
- ^ an Egyptian study: Ghanem H et al. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: A randomized controlled trial. Fertil Steril 2009 Mar 5; [e-pub ahead of print]. Published in Journal Watch General Medicine March 31, 2009
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