A detailed report on the causes, diagnosis, treatment and prevention of male infertility.
Age
The effect of aging on male fertility is not totally clear. However, growing evidence that this might be a factor (though not to the extent that is in women). This evidence suggests that age-related changes in semen of men are not abrupt, but it is a gradual process. Aging may adversely affect a sperm and sperm motility (the ability of sperm to swim quickly and move in a straight line). A 2006 study suggested also that the genetic quality of sperm declines as a man ages. The researchers found that poor sperm motility was associated with fragmentation DNA. This led to some older men who have an increased risk of transmission of genetic mutations that cause dwarfism and possibly other genetic diseases.
Time and lifestyle causes of low sperm count
Most important physical or mental stress can temporarily reduce sperm. Some conditions common that the decrease in sperm, temporarily in nearly all cases, include:
Emotional Stress. Stress may interfere with the hormone GnRH and reduce sperm counts.
Sexual problems. In less than 1% of cases, impotence, premature ejaculation, or psychological or relationship problems contribute to male infertility, although these conditions are usually very treatable. Lubricants used with condoms, including spermicides, oils, and Vaseline, can affect fertility. Astroglide, Replens, mineral oil, or may not be as harmful to sperm. However, oil-based lubricants can damage latex condoms and should be avoided.
Testicular Overheating. Overheating, such as fever high, saunas and jacuzzis, temporarily lower sperm count. Persistent exposure to high temperatures during work may impair fertility. Several studies have not found negative effects on fertility using tight pants, briefs, or athletic supports, even every day.
Substance Abuse. Cocaine or heavy marijuana appears to temporarily reduce the number and quality of sperm by as much as 50%. Sperm have receptors for certain compounds in marijuana that semen may impair the ability to swim and also inhibit their ability to penetrate the egg. Alcohol does not appear to affect fertility, unless it is so abused that causes damage the liver.
Smoking. Smoking impairs sperm motility, reduces the life of the sperm, and may cause genetic changes that affect the offspring. A 2002 trial found that men or women who smoke have lower success rates with assisted reproductive technologies. A previous study reported that men who smoke also have a lower sex drives and less frequent sex.
Malnutrition and deficiencies nutrients. Deficiencies in certain nutrients such as vitamin E, vitamin C, selenium, zinc and folic acid, may be particular risk factors for infertility
Obesity. Obesity may be a risk factor for male infertility. An epidemiological study of 2006 found that an increase in 20 pounds in weight of a man the possibility that the increase of infertility by 10 percent.
Bicycling. Bicicletas or exercise bike has been linked to impotence in men and may also affect fertility. Pressure from the bike seat may damage blood vessels and nerves that are responsible for erections. Mountain biking, which involves riding on a ground out Road, exposes the perineum (the region between the scrotum and anus) to more extreme shocks and vibrations and increases the risk of injury to the scrotum. One study found that men who mountain bike are far more likely to have scrotal abnormalities, including calcium deposits, cysts and twisted veins. Cycle of men who can reduce these risks by:
- Taking frequent rests while biking
- Cycling padded shorts
- Using a padded or specially contoured bike seat that rises and sits high enough on the angle
Genetic factors
Problems in the genes that regulate male fertility and the genetic material of sperm itself are important contributors to infertility problems in men. Indeed, even in men with fertility problems do not know, 19% of the sperm are genetically defective. Some inherited medical conditions also contribute to male infertility. Defective genes can be inherited, caused by environmental assaults (such radiation exposure), or both. Reason some concern is the possibility that these mutations are transmitted to the offspring of men who undergo fertilization techniques that retrieve directly sperm and fertilize the egg. (Under natural conditions, genetically abnormal sperm would be very unlikely to reach and fertilize the egg.)
Defective genetic material. Espermatozoides carry half the genetic material necessary for a human being. Infertile men have been reported as a relatively high percentage of sperm with broken or damaged DNA (the molecular chain that makes a gene).
Genetic Factors Affecting specifically sperm production or quality. Abnormalities in genes that specifically regulate sperm production and quality are important factors in infertility male. Some research suggests that about 10% of cases of male infertility may be due to the problems, probably genetic, in the acrosome. The acrosome is the enzyme-filled membrane in the lid of sperm – its warhead – that is essential for piercing the egg. In one study, pregnancy was impaired if 7% or more of the sperm had abnormalities in the acrosome.
Inherited disorders that affect fertility. Certain inherited disorders can impair fertility. The Examples include:
- Patients with cystic fibrosis often have missing or obstructed vas deferens (the tubes that carry the sperm). In fact, men whose infertility is caused by an inborn missing vas deferens have a 60% chance that they carry the gene for cystic fibrosis (even if you do not have the disease itself).
- Klinefelter syndrome patients carry two X and one Y chromosome (the norm is one X and one Y), which leads to the destruction of the lining of the seminiferous tubules in the testicles during puberty, although most other male physical attributes are unimpaired.
- Kartagener syndrome, a rare disorder that is associated with reversal of position of the major organs, also includes immotile cilia (hair-like cells in the lungs and sinuses that have a structure similar to the tail of the sperm). Sperm motility may also be affected by this condition.
- Polycystic kidney disease, a relatively common genetic disease that causes large cysts to form in the kidneys and other organs during adulthood, can cause infertility as the first symptom if cysts develop in the reproductive tract.
The assaults of the environment
Exposure to toxins, chemicals, or infections may reduce sperm count, either by direct effects on testicular function or by altering hormone systems, although the magnitude of the impact and specific environmental assaults involved are often controversial. Some experts believe is contributing to an overall decline throughout the world in male fertility.
Free radicals (oxidants). The main suspects the link between environmental assaults and infertility are free radicals, also called oxidants. These molecules are unstable, usually containing oxygen, that are released as a natural byproduct of many chemical processes in the body. Infections, chemicals, and other environmental assaults can produce high levels of these particles. High levels may even affect the genetic material in cells. The sperm are particularly vulnerable to the harmful effects this oxidation process. It has been reported that significant levels of oxidants occur in the semen of about 25% of infertile men.
The exposure to estrogen-like hormone-disrupting chemicals and substances. European studies have reported an increasing deterioration in male reproductive health and an increase in cancers of the testis and prostate. Many investigators strongly suspect environmental causes, particularly excessive chemicals that alter hormones as a major cause for both these events. Estrogen-like chemicals found in pesticides and other chemicals are of particular concern. Overexposure to estrogen in males reduces the number of Sertoli cells (cells that are required for the initial development of sperm). Some chemicals that disrupt hormones under investigation include:
Treatment of prostate cancer varies depending on the stage of cancer and may include surgery, radiotherapy, chemotherapy, hormonal manipulation, or a combination of these treatments.
- Bisphenol A is a widely used chemical found in plastic containers and bottles of food that has caused concern. Has potent effects similar to estrogen in low doses. Use of the chemical in female rats has produced prostate abnormalities in their male offspring.
- Phthalates, chemicals chemical used to soften plastics, are under particular scrutiny for their ability to disrupt hormones. Phylates of specific concern are dibutyl phthalate (DBP), found in many products, including cosmetics and products that are sold for children of clay (Fimo, Sculpey). Animals exposed phylates to have impaired sperm and alterations in their reproductive structures, such as the testes. Moreover, there is some concern that exposure in pregnant women may affect the offspring,
- Organochlorines are compounds that combine chlorine and organic substances – usually petrochemicals. Many have effects similar to estrogen, including those used above to make plastics (PCBs) and pesticides (DDT and p, p-DDE). Some, such as dioxins and furans, are byproducts of many chemical processes. Fortunately, most of these chemicals have been banned, but they were widely used in the manufacture before 1970 and are still widespread in the environment. Studies report that when men had a history of moderate or high on the job exposure to pesticides containing organochlorines, their fertility rates were lower than men without such exposures. Studies have found a strong correlation between high levels polychlorinated biphenyls (PCBs) or p, p-DDE with decreasing quality and quantity of sperm. In one study, even men with healthy sperm with high levels of organochlorines a lower sperm count than those with lower levels of these compounds.
Most evidence of the chemistry of the hormone estrogen has occurred in animals and birds. Testing of chemicals containing estrogen have reported little single danger to people. Some studies suggest, however, that exposure to more than one of these chemicals can be very harmful. At this time, there is no strong evidence to support a serious adverse effect on people who have normal exposure to these chemicals. Great efforts are underway to determine the extent of potential damage from these substances.
Hydrocarbons and other industrial chemicals. In a study of 2000 workers at a rubber factory who were chronically exposed to hydrocarbons (ethylbenzene, benzene, toluene and xylene) had below-average semen and sperm quality. (In a 2001 study, men who smoked and worked in plants petrochemicals in particular had poor quality semen.) However, not all large studies have confirmed the effects of these substances, and evidence of significantly effect on fertility is low.
Exposure to heavy metals. Chronic exposure to heavy metals like lead, cadmium, or arsenic may affect sperm quality. Traces of these metals in semen seem to inhibit the function of enzymes in the acrosome, the membrane that covers the head of spermatozoa.
Radiation Treatments. X-rays and other forms of radiation affect any rapidly dividing cell, so the cells that produce sperm are very sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to 2 years to resume normal sperm production and, in severe circumstances, may never recover.
Low sperm
Men fertility problems because of low levels of semen when ejaculation can have a structural abnormality in the tubes transporting the sperm. (A normal amount semen is 2.5 – 5 ml, or about 1 / 2 – 1 teaspoon).
Varicocele
A varicocele is an abnormally enlarged and twisted (varicose) in the vein of the spermatic cord that connects to the testicle. Varicoceles are found in 15-20% of all men and in 25 – 40% of infertile men, although not is unclear how or even if they affect fertility. Tend to occur more commonly (85%) on the left side. Some theories supporting their possible effect on infertility are:
- May varicoceles partially obstruct the passages through which sperm pass.
- May raise varicoceles temperature in the testicles.
- Varicoceles can produce higher levels of nitric oxide, a substance that has beneficial effects on circulation of blood and other functions, but which could, in excess, injure sperm.
- Varicoceles may block the oxygen supply to the sperm.
- Varicoceles have been associated with abnormalities in cellular material in semen. One study suggests that some men may have genetic defects that cause both varicoceles and the decrease of sperm, rather than the varicocele itself causing infertility.
Some reports indicate that only varicoceles that are sufficiently large to feel (or felt) may impact fertility. On the other hand, however, a study of 8 years for men with and without varicoceles found no differences in sperm quality or ability to conceive. Moreover, the few well-conducted studies on repair of varicoceles suggest that the procedure does not improve pregnancy rates. Their effect on fertility remains unclear.
Testosterone Deficiencies and Hypogonadism.
Hypogonadism is the general name a severe deficiency in gonadotropin-releasing hormone (GnRH), the primary hormone that signals the process leading to the release of testosterone and other important reproductive hormones. Low levels of testosterone may result from any cause defects in sperm production.
Hypogonadism is uncommon and more frequently present at birth, usually the result of rare genetic diseases affecting the pituitary gland, which may include selective deficiencies of the hormones FSH and LH, Kallman syndrome, or panhypopituitarism, in which the pituitary gland does almost all hormones. You can also develop later in life brain or pituitary gland tumors or as a result of radiation treatments. Defects in the gene on the X chromosome that regulates that bind to the androgen receptors (male hormone) may also be important causes of male infertility.
Autoantibodies
Autoimmunity is a condition in which the antibodies of the immune system attack specific cells in the body, microinvaders to confuse foreigners. In the case of male infertility, called autoantibodies ( "self" antibodies) that the semen. The antibodies bind to specific parts of the sperm, as the head or tail and, depending on the site attachment, cause several problems:
- May semen stick (agglutinate)
- They can not interact with the mucosa cervical
- They may be unable to penetrate the egg
Some experts believe that the majority of cases the presence of these antibodies do not prevent conception unless a large percentage of sperm are affected.
Vasectomy and Anti-sperm antibodies. Vasectomy, the primary sterility procedure in men, is the most common cause of sperm autoantibodies (also called anti-sperm antibodies). Experts believe that its typical development is as follows:
- Vasectomy works by the rupture of the vas deferens, the tube that carries sperm from the testicles to the urethra (which carries out the penis).
- After vasectomy, sperm are still produced, But instead of just playing passages, which leak out in the body.
- Here, the immune system may perceive as invaders foreign and develop antibodies to attack them.
These antibodies often persist even if a man restores sperm flow the success of the investment process (Vasovasostomy). The persistence of anti-sperm antibodies may result in infertility.
Other causes of autoantibodies. Antibody against the sperm can also appear in men without previous vasectomies and have been reported to be present in 10% of all men with fertility problems. May be linked to genital infections or injury, although the cause is usually not known.
Retrograde ejaculation
Retrograde ejaculation occurs when the muscles of the urethra do not pump properly during orgasm and sperm are forced backward into the bladder instead to move away from the urethra. Semen quality is often affected.
Retrograde ejaculation may be the result of several conditions:
- Surgery to the bottom of the bladder or prostate (the most common cause of retrograde ejaculation)
- Diabetes
- Multiple sclerosis
- Back Surgery
- Spinal Cord Injury
Medicines such as tranquilizers, certain antipsychotics, or hypertension medications also can cause temporary retrograde ejaculation.
Syndrome of testicular dysgenesis and other Physical or Structural Abnormalities
Any structural abnormalities that affect the testes, tubes or other structures reproductive health can have a profound effect on fertility.
Testicular dysgenesis syndrome. Testicular dysgenesis syndrome is observed Recently three conditions – impaired sperm production and quality, testicular cancer, and genital tract abnormalities. Environmental factors that increase the damage of oxidants are believed to be responsible.
The genital abnormalities identified with this syndrome are undescended testicles and hypospadias, each of which is associated with infertility:
- Testicles (Cryptorchidism). In some cases, a failure of the testes to descend from the abdomen the scrotum during fetal life. Cryptorchidism is associated with mild to severe impairment of sperm production. In one survey, 38% of young men who had two testes and 10% of men with one undescended testicle were infertile, compared with 5% of the men who had normal testes. Even a undescended testicle may impair fertility. In cryptorchidism, the testes are exposed to the higher internal body heat, but this can not fully explain damage in sperm production that may occur. (Men who suffer from this condition should be aware that even if the testicle is surgically moved to the scrotum, the risk of testicular cancer has increased significantly, making self-care and regular follow-up examinations with a doctor.)
- Hypospadias. It is a birth defect in which the urinary opening is on the underside of the penis, can prevent sperm from reaching the cervix if not surgically corrected.
Blockage in the tubes that carry sperm. Some men are born with an obstruction in the epididymis or ejaculatory pipeline or other problems that affect fertility later. One center reported that 2% of men seeking treatment had no vas deferens.
Anorchia. In a very rare condition known as anorchia is a man born without testicles.
Syringomyelia. This is a disease of the spinal cord that results in no ejaculate at all (aspermia).
Cancer and its treatments
Birth rates between Cancer survivors are only 40 – 85% of normal rates. Certain types of cancer, particularly testicular cancer, affect the production of sperm, often severely. Cancer treatments like chemotherapy and radiation can damage sperm quality and quantity, causing infertility. The closer they are radiation treatments to the reproductive organs, the greater the risk of infertility. Fortunately, while men can not produce sperm, while 5 years after radiation therapy, many men eventually recover their ability to produce sperm. Chemotherapy drugs that harm the function player tends to affect fertility more severely in men than in women. New drug regimens are helping to improve fertility rates.
Adolescent and adult men undergoing cancer treatments who may want to father children should consider banking and freezing their sperm for later use in assisted reproduction treatments. This technique is called sperm cryopreservation. Is recommended for the cryopreservation of sperm American Society of Clinical Oncology in the method with the highest probability of success for men with cancer survivors. However, these methods of banking are not appropriate for children pre-teens being treated for childhood cancers such as leukemia. Researchers are investigating ways in which the transplant stem cells may someday help these children regain their fertility while avoiding the relapse of leukemia.
Infections
There controversy about the effect of infections on infertility. Simply detecting the presence of an infection in infertile men does not necessarily mean that has no relation to the infertility itself. Some experts believe that the immune response to certain infections may release inflammatory factors and oxidants, particulates chemically unstable substances that can damage sperm. The exact impact of this process the sperm is unclear, however. Infections may affect the liquidity and sperm motility sperm, although it is likely that the effects are temporary. Among the infections most implicated in infertility are:
Diseases sexually transmitted. Repeated gonorrhea or Chlamydia trachomatis is the most infections often associated with male infertility. Such infections can cause scarring and block sperm. Papillomavirus, the cause of genital warts, can also impair the function of spermatozoa.
Mycoplasma. Mycoplasma is an infectious organism that appears to bind to sperm cells and are less mobile.
Parotiditis. Parotiditis When developing after puberty, testicular damage in 25% of men affected by the disease. (Interferon, an antiviral drug may help prevent infertility in adult males with active mumps, but the drug is highly toxic and caution is essential.)
Glandular infection in the urinary tract or genitals. Glandular infection that can affect fertility include prostatitis (in the prostate gland) orchitis (in the testicle), Semino-vesculitis (in the glands that produce sperm) or urethritis (in the urethra), perhaps by altering sperm motility. Even after of successful antibiotic treatment, infections in the testes may leave scar tissue that blocks the epididymis.
Other conditions associated with infertility
Medical Conditions. Other medical conditions that can affect male fertility include any injury serious or major surgery, diabetes, HIV, thyroid disease, Cushing syndrome, a heart attack, liver or kidney failure, and chronic anemia.
Medicines
The effects of medicinal quality and sperm count has not been rigorously studied, and many commonly prescribed drugs without knowing whether impair fertility. Anabolic steroids (which are often abused by weight lifters and other athletes) deserve special notice because they are known to affect severe sperm production. Among the other drugs that can affect male fertility are cimetidine (Tagamet), sulfasalazine (Azulfidine), salazopyrine, colchicine, methadone, methotrexate (Folex), phenytoin (Dilantin), corticosteroids, spironolactone (Aldactone), thioridazine (Mellaril), and blocking calcium channels.
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